Ds-160 Vorm

Name*

First NameMiddle NameLast Name
Name of the farm you will be working on.*
Please select the consular office you would like to use.*

JohannesburgCape TownDurban
This will be my 1st year as an H2A worker.*

YesNo
Where would you like DHL to deliver your passport after the consular office has finished with it.*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Country or Region of origin.*
Have you ever held a nationality other that the one named above?*

YesNo
Are you a permanent resident of a country/region other than the Nationality listed above?*

YesNo

PRESENT EMPLOYMENT
Present Employer in South Africa*

AgricultureBusinessHomemakerRetailNot EmployedOther
Please Explain*
Present Employer*

PREVIOUS EMPLOYMENT
Were you previously employed? (YOU MUST ENTER YOUR LAST USA JOB IF YOU HAD ONE)*

YesNo
Previous Employer*
Have you attended an educational institution at a secondary level or above?*

YesNo
School Info*

ADDITIONAL QUESTIONS
Have you belonged to, contributed to or worked for any professional, social or charitable orginization?*

YesNo
Do you have any specialized skills or training, such as firearms, explosives, nuclear, biological or chemical experience?*

YesNo
Have you ever served in the military?*

YesNo
Military Info*
Have you ever served in, been a member of, or been involved with paramilitary unit, vigilant unit, rebel group, guerrilla group, or insurgent orginization?*

YesNo

Please upload a photo of your last U.S visa*

Cancelof
Please upload a photo of your Passport*

Cancelof
Please upload your visa photo*

Cancelof
I agree that my agent does not take any responsibility for information that I have input in correctly*

YesNo
Should be Empty:

PERSONAL INFORMATION