Dependent Visa Employment Authorization Application Form

Dependent Visa Employment Authorization Application Form
Please complete this form to apply for employment authorization as a dependent visa holder. All fields are required unless otherwise specified.
Full Name
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Current Residential Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Dependent Visa Type
Primary Visa Holder’s Name
First NameLast Name
Proposed Employer Name
Job Title / Position Offered
Anticipated Employment Start Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Upload Supporting Documents (e.g., job offer letter, visa copy, etc.)
Cancelof
Should be Empty: