J-1 Irish Work Travel Pilot Program Application Form 2020

VISA AND TRAVEL INFORMATION

PERSONAL REFERENCE

Name*

First Last

Relationship*

Address*

Email*

Enter Email Confirm Email

Contact Number*

PROFESSIONAL REFERENCE

Name*

First Last

Relationship*

Name of Company or Organisation*

Address*

Email*

Enter Email Confirm Email

Contact Number*

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:

How many times?

Please enter a number from 1 to 10.

Name of Program*

Number*

Sponsoring Organisation*

Dates of Previous DS-2019: Start Date*

American Date Format: mm/dd/yyyy

Dates of Previous DS-2019: End Date*

American Date Format: mm/dd/yyyy

Name of Program*

Number*

Sponsoring Organisation*

Dates of Previous DS-2019: Start Date*

End Date*

Have you ever received a J-1 Intern 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*

End Date*

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

Do you have any health issues that might be a barrier to success?*

Select Yes or No

INTENDED START/COMPLETION DATES

NB: When entering in Program Start Date please allow up to 4 weeks for application processing from application submission date now. Also you may enter the US 4 weeks before Program Start Date. We recommend availing of this time to secure internship if you do not already have it organised.

Intended Flight to US Travel Date*

Preferred start date of program (actual on-program dates)*

Note: you can enter up to 30 days prior to the date above. This is the earliest date you can start your Intern position.

Preferred end date of program (actual end-of-program date)*
Date Format: MM slash DD slash YYYY

Note: your program allows a 12 month opportunity and you can depart up to 30 days after the date above

Intended Destination City*
Where do you intend to do your Internship?

Step 1 of 7

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

PERSONAL INFORMATION

PERMANENT ADDRESS

EMERGENCY CONTACT

COLLEGE ATTENDANCE DETAILS

COLLEGE ATTENDANCE DETAILS

VISA AND TRAVEL INFORMATION

PERSONAL REFERENCE

PROFESSIONAL REFERENCE

VISA AND TRAVEL INFORMATION

INTENDED START/COMPLETION DATES

EXPECTATIONS

INTERNSHIP INTERESTS

HISTORIC, SOCIETAL, CULTURAL INFORMATION

HISTORIC, SOCIETAL, CULTURAL INTERESTS INFORMATION

APPLICATION CHECKLIST

Legal

Contact Details

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