Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Phone Number
*
Make sure that your number is accurate and up to date. Employers may use this number to contact you.
Email
*
example@example.com
Country of Origin
*
Please Select
Mexico
Brazil
El Salvador
Guatemala
Honduras
Ecuador
Panama
Nicaragua
Other
Do you have a driver's license in your country of origin?
*
Yes
No
Are you currently in the United States on a visa?
*
Yes
No
What type of visa do you currently have?
*
H-2A
H-2B
When does your visa expire?
*
-
Day
-
Month
Year
Date
Have you worked in the US before with a visa?
*
Yes
No
What Type of visa did you have?
*
H-2A
H-2B
What state did you work in?
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montanta
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolin
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Did you have a driver's license in the US?
*
Yes
No
What state is your license from?
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolin
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
How many years have you worked in the US?
*
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
What was the last year you worked in the US?
*
Please Select
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000 or before
What type of work did you perform while in the US?
*
Landscaping
Construction
Hospitality
Farming
What Company/Companies did you work for?
*
What type of work experience do you have?
*
Landscaping
Construction
Hospitality
Farming
What type of landscaping work did you perform?
*
Mowing
Irrigation
Carpentry
Paver Installation
Retaining Walls
Planting
Mulching
Prunning
Pool Installation
Concrete
Snow Plowing
Snow Shoveling
Other
What type of construction work did you perform?
*
Demolition
Masonry
Carpentry
Concrete
Roofing
Plumbing
Electrical
Welding
Other
What type of hospitality work did you perform?
*
Hotel Service
Cleaning
Restaraunt
Dishwashing
Waiter/Waitress
Bartender
Ski Lift Operator
Ski Resort Hospitality
Other
Reimbursement
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