J-1 Trainee Program Application Form

Step 1 of 7

Please Have Required Documents Ready for Upload in Order to Complete Form
1. SIGNED COPY OF RULES & REGULATION FORM PDF (Download link)
2. TIPP PREPARATION QUESTIONAIRE WORD DOC (Download link) (To assist you in filling out this form please refer to Sample Training Plan and Notes on Training Plan)
3. WORKER'S COMPENSATION DOCUMENT PDF (Ask your Trainee provider to supply this to you)
4. EMPLOYER'S COMPANY BROCHURE PDF (If available)
5. POST SECONDARY DEGREE/ PROFESSIONAL CERT PDF
6. CV or RESUME PDF
7. REFERENCES 1 PERSONAL 1 PROFESSIONAL(CONTACT DETAILS ONLY) PDF
8. Passport JPEG
9. Financial Security.Download, print and sign.
10. Proof of Employment PDFS (ONE FOR EACH EMPLOYER) WITH COMPANY LETTERHEAD AND CONTACT DETAILS
11. COPY OF PREVIOUS US VISAS IF APPLICABLE PDF
12. COPY OF IRISH VISA (THIRD PART NATIONALS) IF APPLICABLE PDF

J-1 TRAINEE VISA 2022 PROGRAM APPLICATION

PERSONAL INFORMATION

Important! This information must appear exactly as it does on your passport.
Full Name*
First Middle Last
Date of Birth*
MM slash DD slash YYYY

American Date Format: mm/dd/yyyy
Place of Birth*
Nationality*
Citizen of*
must be a citizen of Ireland
Permanent Resident of*
If you have graduated, are you currently working?
Please select yes or no
PERMANENT ADDRESS
Address*
Town/City*
County/PostCode*
Country*
Phone*
Mobile*
Email*
Enter Email Confirm Email
EMERGENCY CONTACT
Name*
First Last
Relationship*
Address*
Town/City*
County/PostCode*
Country*
Phone*
Mobile*
Email*
Enter Email Confirm Email

QUALIFYING EVIDENCE
To qualify for the J1 Trainee Visa you must either have:

A. Five years experience in the field you will be training in, or

B. A degree or professional certificate from a post-secondary academic institution AND at least one years experience within the field you are planning to train within (noting that the degree must also be in the same field)

Complete the relevant section depending on which category applies.

A. Five Years Experience In The Field
Company 1 Name
Company 1 Address
Company 1 Contact name
Company 1 Phone Number
Company 1 Email
Dates Employed
MM slash DD slash YYYY

American Date Format: mm/dd/yyyy
To
MM slash DD slash YYYY

American Date Format: mm/dd/yyyy
Company 2 Name
Company 2 Address
Company 2 Phone Number
Company 2 Email
Dates Employed
MM slash DD slash YYYY

American Date Format: mm/dd/yyyy
To
MM slash DD slash YYYY

American Date Format: mm/dd/yyyy
If you are using more than two companies to prove the criteria please submit an additional document with the relevant information.
B. Post secondary Academic Institution plus One Years Experience In The Field
COLLEGE ATTENDANCE DETAILS
Institution Name
Institution Address
Program Course
(Eg. Bachelor of Business Studies BSc Business, Masters of Elkectrical Engineering MSc Engineering)
Dates Attended
MM slash DD slash YYYY

American Date Format: mm/dd/yyyy
To
MM slash DD slash YYYY

American Date Format: mm/dd/yyyy
Graduation Date
MM slash DD slash YYYY

American Date Format: mm/dd/yyyy
WORK EXPERIENCE
Company 1 Name
Company 1 Address
Company 1 Contact name
Company 1 Phone Number
Dates Employed
MM slash DD slash YYYY

American Date Format: mm/dd/yyyy
To
MM slash DD slash YYYY

American Date Format: mm/dd/yyyy
Total # Months
Company 2 Name
Company 2 Address
Company 2 Contact name
Company 2 Phone Number
Dates Employed
MM slash DD slash YYYY

American Date Format: mm/dd/yyyy
To
MM slash DD slash YYYY

American Date Format: mm/dd/yyyy
Total # Months
If you are using more than two companies to prove the criteria please submit an additional document with the relevant information. Written confirmation of your employment (including dates) and proof of graduation to be upload on last page of this form.

VISA AND TRAVEL INFORMATION
Have you ever received a J-1 visa to enter the US?
If yes, please fill out the following for each visa:
Name of Program*
Number*
Sponsoring Organisation*
Dates of Previous DS-2019: Start Date*
MM slash DD slash YYYY

American Date Format: mm/dd/yyyy
End Date*
MM slash DD slash YYYY

American Date Format: mm/dd/yyyy
Have you ever received a J-1 Intern or Trainee visa to enter the US?
If yes, please fill out the following for each visa:
Name of Program*
Number*
Sponsoring Organisation*
Dates of Previous DS-2019: Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
Have you ever applied for a visa to immigrate permanently to the US?
Select Yes or No
Have you ever been arrested or convicted of a crime?*
Select Yes or No
Have you ever been refused a visa by the US Embassy?*
Select Yes or No
INTENDED START/COMPLETION DATES
Intended Flight to US Travel Date*
MM slash DD slash YYYY

American Date Format: mm/dd/yyyy
Preferred start date of program (actual on-program dates)*
MM slash DD slash YYYY

Note: you can enter up to 30 days prior to the date above
Preferred end date of program (actual end-of-program date)*
MM slash DD slash YYYY

Note: your program allows an 18month opportunity and you can depart up to 30days after the date above

EXPECTATIONS
How did you first learn of the J-1 Trainee Program?*
What attracted you to the J-1 Trainee Program and what do you expect to gain?*
What about the J-1 Trainee Program do you believe will prove most beneficial upon return to your home country?*
TRAINING PROGRAM INTERESTS
Describe your ideal training program?*
Have you begun to look for a training program?*

HISTORIC, SOCIETAL, CULTURAL INFORMATION
The United States Department of State believes that a participant coming to the United States on a J1 Program – should not only gain a valid internship to help with their future career – but should also gain a better understanding of America and it’s History, Society & Culture. We agree!! Tell us a little bit about what might interest you while you are here and we will develop a program of learning for you. (check all that apply).
HISTORIC, SOCIETAL, CULTURAL INTERESTS INFORMATION
check all that apply
History
The American Revolution
19th Century Industrialization
20th Century
Society
The Political System
Local Politics
Volunteering Opportunities
Culture
African American Culture
Native American Culture
Other Cultures

Sports
American Football
Baseball
Basketball
Bowling
Cycling
Horse Racing
Soccer
Softball
Swimming
Track & Field

The Arts
Art Galleries
Movies
Music**
Theater
Literature
*
**What genre of Music?

APPLICATION CHECKLIST
RULES & REGULATION PDF*

Drop files here or

Accepted file types: pdf, Max. file size: 2 MB, Max. files: 2.

Upload Required PDF Document. Allow time for document to upload (Max file sizes: 2MB).
TIPP PREPARATION QUESTIONAIRE WORD DOC*

Drop files here or

Accepted file types: docx, Max. file size: 2 MB, Max. files: 2.

Upload Required Word Document. Allow time for document to upload (Max file sizes: 2MB).
WORKER'S COMPENSATION DOCUMENT PDF*

Drop files here or

Accepted file types: pdf, Max. file size: 2 MB, Max. files: 2.

Upload Required PDF Document. Allow time for document to upload (Max file sizes: 2MB).
EMPLOYER'S COMPANY BROCHURE PDF (If available)

Drop files here or

Accepted file types: pdf, Max. file size: 2 MB, Max. files: 2.

Upload Required PDF Document. Allow time for document to upload (Max file sizes: 2MB).
POST SECONDARY DEGREE/PROFESSIONAL CERT PDF*

Drop files here or

Accepted file types: pdf, Max. file size: 2 MB, Max. files: 2.

Upload Required PDF Document. Allow time for document to upload (Max file sizes: 2MB).
CV or RESUME PDF*

Drop files here or

Accepted file types: pdf, Max. file size: 2 MB, Max. files: 2.

Upload Required PDF Document. Allow time for document to upload (Max file sizes: 2MB).
REFERENCES PDF*

Drop files here or

Accepted file types: pdf, Max. file size: 2 MB, Max. files: 2.

Upload Required PDF Document. Allow time for documents to upload (Max file sizes: 2MB).
PROOF OF FUNDS PDF*

Drop files here or

Accepted file types: pdf, Max. file size: 2 MB, Max. files: 2.

Upload Required PDF Document. Allow time for document to upload (Max file sizes: 2MB).
PROOF OF EMPLOYMENT PDF(s) with company letterhead*

Drop files here or

Accepted file types: pdf, Max. file size: 2 MB, Max. files: 10.

Upload Required PDF Document. Allow time for document to upload (Max file sizes: 2MB).
PASSPORT JPEG*

Drop files here or

Accepted file types: jpg, Max. file size: 2 MB, Max. files: 2.

Upload Required JPG. Allow time for documents to upload (Max file size: 2MB).
COPY OF PREVIOUS US VISAS PDF (If applicable)

Drop files here or

Accepted file types: pdf, Max. file size: 2 MB, Max. files: 2.

Upload Required PDF Document. Allow time for document to upload (Max file sizes: 2MB).
COPY OF IRISH VISA (THIRD PART NATIONALS) PDF (If applicable)

Drop files here or

Accepted file types: pdf, Max. file size: 2 MB, Max. files: 2.

Upload Required PDF Document. Allow time for documentto upload (Max file sizes: 2MB).
APPLICATION CHECKLIST
Check*
Rules & regulations signed (pdf – 1-doc, 2-pages, correct orientation)
Check*
TIPP Preparation Questionaire Word doc
Check*
Worker's Compensation Document (pdf)
Check
Company Brochure (If available) (pdf)
Check*
Post secondary degree/ professional cert (pdf, correct orientation)
Check*
CV or Resume (pdf, correct orientation)
Check*
References (pdf with 1 personal and 1 professional)
Contact Details Only: Name, Contact Number, Email, Address
Check*
Financial Security (pdf, correct orientation)
Check*
Proof(s) of Employment (pdf(s), correct orientation)
PDFs for each employer with company letter
Check*
Photocopy of Personal Details in your Passport (JPEG – professionally scanned, correct orientation)
exclude
Check if applicable
Copy of Previous US Visas (if applicable) (pdf, correct orientation)
Check if applicable
Copy of Irish Visa (Third Country Nationals) (pdf, correct orientation)
Name
This field is for validation purposes and should be left unchanged.

Step 1 of 7

Please Have Required Documents Ready for Upload in Order to Complete Form

J-1 TRAINEE VISA 2022 PROGRAM APPLICATION

PERSONAL INFORMATION

PERMANENT ADDRESS

EMERGENCY CONTACT

QUALIFYING EVIDENCE

To qualify for the J1 Trainee Visa you must either have:

A. Five Years Experience In The Field

B. Post secondary Academic Institution plus One Years Experience In The Field

COLLEGE ATTENDANCE DETAILS

WORK EXPERIENCE

VISA AND TRAVEL INFORMATION

INTENDED START/COMPLETION DATES

EXPECTATIONS

TRAINING PROGRAM INTERESTS

HISTORIC, SOCIETAL, CULTURAL INFORMATION

HISTORIC, SOCIETAL, CULTURAL INTERESTS INFORMATION

APPLICATION CHECKLIST

APPLICATION CHECKLIST

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