H2A Job Application Form

H2A APPLICATION FORM

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www.vpsa.co.za

VPS Recruitment regrets to inform you our company policy prevents us from processing any candidates with a previous criminal record and no candidate will be processed that is referenced by another H2A co-worker without prior approval from the U.S. Representative.

Returning H Workers: Effective September 2, 2025, the Department of State will update the categories of applicants that may be eligible for a waiver of the non-immigrant visa interview. All non-immigrant visa applicants, including applicants under the age of 14 and over the age of 79, will generally require an in-person interview with a consular officer. All H2A/H2B applicants will automatically attend a interview at the consulate.
Before completing this application form please note that you have to have at least 3 months experience in the spesific field you are applying for. Completing this application form does not in any way guarantee the applicant a job offer, this is used for administration purposes only! If a opportunity opens up for your application VPS Recruitment will be in contact with you. VPS RECRUITMENT SOUTH AFRICA Company policy prevents us from processing any candidates with a previous criminal record and no candidate will be processed that is referenced by another H2A co-worker without prior approval from the U.S. Representative.*

I AGREEI DO NOT AGREE
PLEASE NOTE: The consulate has the right to call you in for an interview at any given time for Biometerics (fingerprints). In a interview they can send you for a medical evaluation, this will mean your application will be pending on the results.
Confidential Information.The Applicant shall not, during the term of this Agreement or at any time thereafter, make unauthorized use of, or divulge to any other person or entity the Company's Employer information, confidential or other information, whether or not marked as confidential or proprietary (the “Information”), as confidential and to not disclose, discuss or reveal such Information to a third party or on any social network platform without the prior written consent of the Agent/Consultant, unless required by applicable Law or order of a Government Authority to disclose any such Information.This Confidentiality Covenant shall apply to all information provided by the Company under this Agreement.At all times during the term of this Agreement, and after its termination, the Applicant shall take all reasonable precautions to protect the integrity of and shall refrain from any use or divulgence of the Company's confidential information including, but not limited to: all files, resource information, records, documents, specifications, equipment, customer lists, and similar items relating to the business of the Company, or copies thereof, whether the originals or copies were prepared by Applicant or otherwise came into Applicant's possession.The confidential information described above shall remain the exclusive property of the Company and shall not be shared under any circumstances whatsoever without the express prior written consent of Company.If the Applicant breaches or threatens to breach this Agreement, the Company shall be entitled to obtain injunctive relief containing such mandatory or prohibitory clauses as are necessary to prevent the continued breach of this covenant of confidentiality. The Company shall also be entitled to any other remedies provided under this contract or at law. If the Company elects to enforce this Paragraph through a court of law of appropriate jurisdiction, the Applicant shall be liable for payment of all court costs, attorney’s fees, and necessary expenditures, which the Company incurs.

IMPORTANT IMFORMATION TO TAKE NOTE OF:
Your Process May Be Stopped or Denied From The Agency if:
If you do not meet the necessary or minimum requirements.
If you are dishonest on your application. We have the right to cancel your application if we run a background check and find any offences.
We will only deal with the Applicant directly, no other person or party may request information or updates.
Applicant is responsible for updating information on a regular basis.
Arrogance, crude language, WhatsApp messages, WhatsApp calls will not be tolerated, please email us.
We will not accept any queries or communication or requests unfulfilled by third parties such as the U.S. Consulate or DHL. Each applicant must follow up or dispute his/her own application or process with these parties directly.
Should you be denied by the consulate or the employer during the process, we will take no responsibility for this, you will have to go through the process again.
U.S. Consulate fee is non-refundable, should you require assistance, make contact with them directly.
No employer's information may be send to other people agencies or shared on social media.

By signing hereunder, I ackowledge and accept the confidentiality agreement.
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PERSONAL INFORMATION
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email address
ID Number
Date of birth

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
DO YOU HAVE FARMING EXPERIENCE WITH REFERENCES?*
When are you available for employment*

MonthDayYear
Date
YESNO
YESNO
If you have to resign at your current employment, what date will you be available to travel abroad?

MonthDayYear
Date
Code 8Code 10Code 14CDLOther
DO YOU HAVE ANY HEALTH PROBLEMS (ALLERGIES, HYPERTENTION, DIABETES, DISABILITIES, SERIOUS MEDICAL CONDITION), IF YES, GIVE DETAILS AND LIST MEDICATIONS?*
HAVE YOU EVER BEEN CHARGED WITH DRIVING WHILE INTOXICATED IN THE PAST 5 YEARS? IF YES, PLEASE EXPLAIN? *
YESNO
IF YES, PLEASE EXPLAIN? *
I understand
YESNO
PASSPORT NUMBER:
ISSUE DATE

MonthDayYear
Date
EXPIRY DATE

MonthDayYear
Date
Have you ever worked in the United States? IF YES, Provide dates and duration?
HAVE YOU EVER APPLIED FOR A USA VISA? YES/NO. IF YES WAS THE VISA: ISSUED OR DENIED?
TYPE OF VISA
WHICH CONSULATE
DATE ISSUED

MonthDayYear
Date
HAVE YOU EVER WORKED IN THE USA BEFORE? YES / NO *
USA EMPLOYER & CONTACT NUMBER:
DATES EMPLOYED
JOB DESCRIPTION
Have you ever been recruited by SA Agents or USA Agents for the H2A Program (Y/N)? IF YES, Supply the contact person of case agent and company name*
SINGLEMARRIEDDIVORCEDWIDOWED
NEAREST RELATIVES, IF MARRIED STATE SPOUSE INFORMATION AS 1 OF THE RELATIVES: RELATIVE 1 NAME
Relative 1 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
EDUCATIONAL QUALIFICATIONS

Provide highest level of education details.
NAME OF INSTITUTE / SCHOOL
Address of Educational institute / school

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number of Educational institute / school
Please enter a valid phone number.Format: (000) 000-0000.
Qualification (e.g. Gr. 12 / Bachelor's degree in Computer Science)
Date started

MonthDayYear
Date
Date completed

MonthDayYear
Date
RESUME:
Please write a short but detailed resume about your skills and list the equipment machinery or work you have physical experience in (example: My name is..., I have farming experience with Trimble GPS systems, Case harvesters, Cattle farming: (Sharola, Brahman and Bonsmara breeds)

I have experience in the following:

Administering of basic shots, Castration, De-horning, helping with the delivery of calves, Ear tagging, Feeding and breeding programs, Branding, weaning of calves and feeding and care thereafter…
Your resume. Shortly list your skills and experience *
USA EMPLOYMENT HISTORY
1. Company name
List experience, job duties and responsibilities in full for this position
Contact Person Name & Surname
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Employer 1 start date

MonthDayYear
Date
Reason for leaving
2. Company name
List experience, job duties and responsibilities in full for this position
Contact Person Name & Surname
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Employer 1 start date

MonthDayYear
Date
Reason for leaving
RSA EMPLOYMENT HISTORY
1. Company name*
List experience, job duties and responsibilities in full for this position*
Contact Person Name & Surname*
Phone Number - Employer 1*
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Reason for leaving*
2. Company name*
List experience, job duties and responsibilities in full for this position*
Contact Person Name & Surname*
Phone Number - Employer 1*
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Reason for leaving*
AGRICULTURE WORK EXPERIENCE
CropsCattleDairyOther
LIST ALL FARM WORK EXPERIENCE YOU HAVE – VERY IMPORTANT
TRACTORS
COMBINES/HARVESTINGMACHINES
TILLAGE& CULTIVATION EQUIPMENT
SILAGE & HAYMAKING EQUIPMENT
SPRAYERS
OTHER FARM EQUIPMENT
EARTHMOVING EQUIPMENT
TRUCKS
POOR (Not familiar with basic tools, little experience with mechanical repairs or maintenance)FAIR (Familiar with basic tools & equipment, capable of minor repairs & maintenance with some supervision. Can operate a welding and grinding machine)GOOD (Familiar with all hand tools & workshop equipment, welding machines & grinders. Capable of complex overhauls& repairs without supervision)
POOR (Not familiar with mechanical repairs or maintenance)FAIR (Capable of minor repairs & maintenance with some supervision. Can operate a welding and grinding machine, oil changes, tyre changes, fault finding, basic service)GOOD (Familiar workshop equipment, welding machines & grinders. Capable of complex overhauls & repairs without supervision)RED SEAL QUALIFIED

FARMING EXPERIENCE

Rows	None	Marginal	Adequate	Highly skilled
ARTIFICIAL INSEMINATION
CATTLE FARMING
DAIRY
CROP FARMING
IRRIGATION

Specify breed of cattle you have experience in
Specify crops you have experience in
Specify irrigation equipment you have experience in
Specify duties with regards to above (cattle, crops, irrigation, artificial insemination)
YesNoIF NO, will you be able to make arrangements for financing this process in short period of time?
YESNO
MoneyExperienceReturn worker
Where did you hear about VPS Recruitment?*

CONFIRMATION

I, the undersigned, confirm that the above-mentioned information is correct and true.
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date

MonthDayYear
Date
Signature

Clear

WILLBERFORCE RIGHTS AND INFO

https://travel.state.gov/content/travel/en/us-visas/visa-information-resources/temporary-workers.html
AGREEDISAGREE
Email
Should be Empty:

By signing hereunder, I ackowledge and accept the confidentiality agreement.

PERSONAL INFORMATION

EDUCATIONAL QUALIFICATIONS

RESUME:Please write a short but detailed resume about your skills and list the equipment machinery or work you have physical experience in (example: My name is..., I have farming experience with Trimble GPS systems, Case harvesters, Cattle farming: (Sharola, Brahman and Bonsmara breeds)

I have experience in the following:

Administering of basic shots, Castration, De-horning, helping with the delivery of calves, Ear tagging, Feeding and breeding programs, Branding, weaning of calves and feeding and care thereafter…

USA EMPLOYMENT HISTORY

RSA EMPLOYMENT HISTORY

AGRICULTURE WORK EXPERIENCE

LIST ALL FARM WORK EXPERIENCE YOU HAVE – VERY IMPORTANT

CONFIRMATION

WILLBERFORCE RIGHTS AND INFO

Email

RESUME:
Please write a short but detailed resume about your skills and list the equipment machinery or work you have physical experience in (example: My name is..., I have farming experience with Trimble GPS systems, Case harvesters, Cattle farming: (Sharola, Brahman and Bonsmara breeds)