Анкета для Участия Work&Travel USA | www.gepkaz.com | program@gepkaz.com

Work and Travel 2022

Регистрация Участника Пожалуйста, заполните все поля на английском
Personal information
Last Name(as in passport) *
First Name (as in passport) *
Date of Birth *

Day Month Year
Дата рождения
Age| Возраст
Возраст
Email *
example@example.com
Skype *
Скайп адрес
Phone Number *

Area Code Phone Number
City of Birth *
Город Рождения
Citizenship *
Гражданство
Marital status| Семейное положение *

Женат/замужем Не женат гражданский брак вдовец/вдова
Постоянный Адрес
Address *

street

Street Address Line 2

City

Country
Postal Code
Adress if different from aboe

Continue registration
Full Name as in passport

First Name Father's Name/Otchestvo Last Name
International Passport number *
Номер паспорта
City of passport issuance
Country of passport issuance
Int'l Passport issuance date

Day Month Year
Date
Int'l Passport Expiry Date

Day Month Year
Date
Have you ever lost your international passport? If yes, please indicate lost passport number and issuing country.
Education Information
University Name: *
Department/Faculty *
специальность и курс
University entry year *
B каком году поступили на учебу
University completion year *
в каком году заканчиваете или закочили учебу
Your English Level *

Fluent/свободное владение Advanced/Продвинутый intermediate/Среднии Elementary/Базовый
Travel Information
Desired employment start date
Desired arrival date to the US
Desired arrival airport
How long are you planning to stay in the US?
Desired return date to country of residence ?
Any siblings participating in the WT program this year? If yes, indicate Full Name of the sibling
Any chronic diseases preventing from program participation?
Any arrests, convictions or imprisonments?
Family Information
Mother's Full Name and Home address: *

Name

Street Address Line 2

City

Country
Mother's Place of Work
Mobile number of mother *

Area Code Phone Number
Father's's Full Name and Home address: *

Name

Street Address Line 2

City

Country
Father's Place of Work *
Mobile number of father *

Area Code Phone Number
Brother and sisters names if any *
имя и номер телефона друга или подруги
Mobile number of siblings *

Area Code Phone Number
Your Best friend's name and mobile phone with country code *
имя и номер телефона друга или подруги

Work and Travel 2022

Personal information

Постоянный Адрес

Education Information

Travel Information

Family Information

Questionnaire

References

Additional Information