Form I-765 Application for Employment Authorization
Last Name
*
First Name
*
Middle Name
Other Names Used - Name 1 (Last, First, Middle)
*
Other Names Used - Name 2
Mailing Address
In Care Of
Street
*
Apt
City
*
State
*
ZIP
*
Physical Address
Same as Physical Address
*
Yes
No
Physical Address - Street
*
Apt
City
*
State
*
ZIP
*
Citizenship and USCIS Identifiers
List all countries of citizenship
*
A-Number
USCIS Online Account Number
U.S. Taxpayer Identification Number
Personal Information
Gender
*
Please Select
Male
Female
Other
Prefer not to say
Marital Status
*
Please Select
Single
Married
Divorced
Widowed
Separated
Other
Previously filed I-765
*
Yes
No
Birth Information
City
*
State/Province
*
Country
*
Date of Birth
*
-
Month
-
Day
Year
Date
Passport and Arrival Information
Passport Number
*
Travel Document Number
Country of Issuance
*
Passport Expiration Date
*
-
Month
-
Day
Year
Date
I-94 Number
*
Date of Last Arrival
*
-
Month
-
Day
Year
Date
Place of Last Arrival
*
Immigration Status at Arrival
*
Current Status
*
SEVIS Number
Eligibility Category and Additional Category-Specific Information
Eligibility Category (Q27)
*
STEM OPT Degree
STEM OPT Employer Name
STEM OPT E-Verify Number
H4 Spouse I-797 Receipt Number
Ever arrested
Yes
No
I-140 Receipt Number
Criminal question
Signature
Signature
*
Date (Signature)
*
-
Month
-
Day
Year
Date
Submit Application
Submit Application
Should be Empty: