Name of CIEE Representative:
Country:
Interviewed by (Name):
Representative Code:
Date (day/month/year):
WORK & TRAVEL USA
APPLICATION
A Cultural Exchange Program
Summer 2018
8 of 9
ciee.org/in-the-usa/work/work-travel-usa
1-888-COUNCIL (268-6245)
contact@ciee.org
Updated: 8/8/17
FEE DISCLOSURE
(FEES THAT WILL BE COLLECTED BY THE CIEE AGENT, CIEE OR THE U.S. GOVERNMENT)
Fee
Amount
Inclusions
(Please specify currency: )
Program fee
-
Application fee
-
Agent
support
pre-departure
-
U.S.
Sponsor
support
-
Orientation
-
Insurance
Plan
(for
policy
details
visit
www.ciee.org/insurance)
-
Screening
for
program
-
English
eligibility
test
-
Administrative
costs
-
Translation
of
documents
SEVIS fee
- U.S. government administrative cost
Visa
interview
fee
- U.S. government administrative cost
Promotion
-
Discount
Placement fee
- All costs related to finding a placement
Expedite fee
-
Expedited
forms
and/or
application
review
Housing fee
Transportation fee
Other services
Total fees (excluding airfare)
Flight (estimated cost)
- Round-trip airfare (this is the typical cost – actual
price will depend on destination and dates selected)
Cancellation Policy:
Other program costs and pricing notes:
PARTICIPANT FEE AGREEMENT
I verify that I was provided with a copy of the CIEE Work & Travel USA application, which includes the full terms and conditions for the
program. I confirm that I have reviewed the complete pricing information in this document and fully understood the costs of the program
before I paid a non-refundable deposit. I understand that wages might not cover the entirety of program and living expenses and that I should
have access to additional personal funds.
Except as specifically modified herein, the terms of the CIEE Work & Travel USA application I previously signed remains in full force and effect.
Name Printed:
Signature:
Date
(DD/MM/YYYY)
:
IST Plus
IST Plus
United Kingdom
UK/IST
UK GBP (£)
Independent Job: £545
Job secured through CIEE: £620
$35 included in your application fee
$160 PAYABLE DIRECTO TO US EMBASSY AT TIME OF BOOKING INTERVIEW
N/A
Included in Programme fee if Job secured through CIEE
N/A
N/A
N/A
N/A
N/A
N/A - flights purchased independently of IST Plus and CIEE
Full cancellation policy can be found at istplus.com/watusa
WORK & TRAVEL USA
JOB OFFER
A Cultural Exchange Program - Summer 2018
1 of 2
Participants visit:
ciee.org/in-the-usa/work/work-travel-usa Employers visit:
ciee.org/partner/employers/work-travel-usa
Participants call:
1-888-COUNCIL Employers
call:
1-866-609-CIEE
Updated: 8/3/17
EMPLOYER INFORMATION
(ALL FIELDS REQUIRED. Worker’s compensation and business license documentation will be required by email or fax for processing.)
Company
name:
Phone:
d/b/a
(if applicable)
:
Fax:
Street:
TaxID/EIN:
City:
State:
Zip:
Website:
Worker’s
Comp
(WC)
Provider:
WC
Policy
#:
We agree to provide proof of worker’s compensation insurance (or exemption from requirement) and business license as part of the vetting and
approval process.
Yes
No
Note: For the business license requirement, a qualifying document is typically a certificate/permit/license issued by the state, county, or city, which authorizes you to conduct business and is
renewed on an annual basis. For any questions regarding qualifying documents, please call our dedicated toll-free employer line at 866-351-9949.
What does your company do:
Worksite address
(if different from above)
Street:
City:
State:
Zip:
Nearest major city:
Distance to nearest major city:
Total number of international students at this location:
Total number of all employees at this location:
Which other J-1 sponsor companies are you using to provide seasonal help?
Offer made to
(student name)
:
Dates of employment
(DD/MM/YYYY)
:
Maximum of four (4) months
From:
To:
We have previously employed this Exchange Visitor.
Name of Previous Sponsor:
Supervisor’s
name:
Supervisor’s
title:
Supervisor’s
phone:
Supervisor’s
email:
Off-season
phone:
JOB INFORMATION
Student
job
title:
Is
this
a
seasonal
position?
Yes
No
Please describe the seasonal nature of this position:
Job description:
Wage per hour:
Tips?
Yes
No
Estimated weekly wage including tips:
Average number of hours per week:
Is an end-of-season bonus available?
Yes
No
If yes, please provide details:
Overtime required?
Yes
No
Overtime available?
Yes
No
Overtime wage per hour:
State minimum wage per hour
(if greater than federal):
Wage pay schedule:
Weekly
Bi-weekly
Monthly
Are meals provided during shift?
Yes
No
Cost to student for meals?
Yes
No
Estimated cost of meals:
Additional Wage Provisions/Deductions: Identify any training costs, equipment or uniform fees, or additional paycheck deductions.
Supplies required: Identify any uniforms, supplies, or equipment the student must supply.
What opportunities will the participant have to experience U.S. culture locally or through the workplace?
HOUSING INFORMATION
Who Provides Housing?
Employer
Participant
International Representative (Rep initials:
)
Housing address:
Cost of housing per week:
Estimated cost of utilities:
Housing deposit:
Is housing furnished?
Yes
No
How many people share a house?
How many people share a room?
Distance from job site:
Transportation provided:
Yes
No
Cost of transportation:
Estimated commute time:
Type of transportation:
If housing not provided, will you assist participant in finding house?
Yes
No
Other housing recommendations:
Distance from job site:
Estimated cost of housing:
Estimated cost of transportation:
You can download this as a separate PDF to email to your US Employer
at istplus.com/apps/watjof2018
IF YOU HAVE SECURED A JOB THROUGH CIEE VIRTUAL HIRE YOU DO NOT NEED TO
COMPLETE OR INCLUDE THIS PAGE IN YOUR APPLICATION.
WORK & TRAVEL USA
JOB OFFER
A Cultural Exchange Program - Summer 2018
2 of 2
Participants visit:
ciee.org/in-the-usa/work/work-travel-usa Employers visit:
ciee.org/partner/employers/work-travel-usa
Participants call:
1-888-COUNCIL Employers
call:
1-866-609-CIEE
Updated: 8/3/17
EMPLOYER SECTION
TERMS AND CONDITIONS
The undersigned Employer agrees to the following conditions:
1. I am an authorized representative of the company named on this document with author-
ity to enter into this agreement.
2. We acknowledge the aims and objectives of the CIEE Work & Travel USA program as a
U.S. Department of State authorized Exchange Visitor Program, with the purposes of pro-
viding cultural exchange opportunities to qualified foreign students, and advancing the
public diplomacy goals of the United States.
3. We understand that the J-1 Exchange Visitor Program is intended to provide educational
and cultural exchanges and thus agree to provide at least one cultural exchange opportu-
nity to participants at our location for each hiring season.
4. We will adhere to all applicable regulatory provisions that govern this program, and all
CIEE policies which relate thereto.
5. We warrant that the relationship between the employer and student will comply with all
Federal, State and Local laws regarding employment and occupational health and safety.
6. I understand that federal statutes such as Title VII of the Civil Rights Act of 1984, the
Immigration Reform Act of 1986 and the Immigration and Nationality Act, as well as a
large number of state statutes prohibit discrimination in the hiring of foreign nationals.
This means that in virtually all cases, it is illegal for an employer and for a sponsor such as
CIEE to engage in discrimination based on national origin, gender, race, religion, etc.
7. The salary and other terms of employment meet or exceed all federal, state, and local
minimum wage and overtime requirements and, to my knowledge, are commensurate
with those of our U.S. employees.
8. This participant will be covered by Worker’s Compensation insurance or we are exempt
by state law from this requirement.
9. This participant will be an employee, not an independent contractor.
10. I understand that participants may undertake a period of employment of no more than
four months.
11. The job we are offering is the result of a one-time occurrence, a peak seasonal need, or
an intermittent need and will not displace year-round positions for American workers.
12. I understand that hiring year-round for non-seasonal positions is inconsistent with the
intent of the Summer Work Travel program. I have disclosed to CIEE our seasonal hiring
needs and the full-range of our use of J-1 programs through any sponsor.
13. I understand that we are not permitted to employ J-1 Summer Work Travel partici-
pants if we have experienced layoffs within 120 days of the participant’s employment,
and/or if we currently have workers on lockout or on strike. We agree to notify CIEE
immediately should these situations occur at our company prior to the end of this par-
ticipant’s employment.
14. Neither we nor I have accepted compensation from any party in return for offering
this job.
15. We have fully explained the terms of employment and job details to this participant.
16. I understand that the Department of State requires CIEE to vet all potential host employ-
ers according to the regulations of the J-1 Summer Work Travel Program.
17. We understand that this job offer is not valid until vetted and approved by CIEE, and the
participant cannot work at my company without written approval from CIEE. I agree to
cooperate with CIEE in this process.
18. We agree to provide proof of worker’s compensation insurance (or exemption from
requirement) and business license as part of the vetting and approval process.
19. If our job offer includes housing, the housing we provide will meet all applicable local laws
and regulations, including those with respect to ventilation, utilities, and occupancy rates.
I understand CIEE reserves the right to vet housing to be provided to participants.
20. We further attest that any wage deductions we will take to cover the cost of employee
housing does not violate the Fair Labor Standards Act regulations set forth at 29.CFR.531.
We further agree to obtain advance permission in writing from the student for any pay-
roll deductions or changes in deductions.
21. We understand that CIEE is responsible for maintaining contact with participants
throughout their program.
22. I understand that I may view all fees charged to CIEE participants by visiting
https://www.ciee.org/partner/employers/work-travel-usa/fee-disclosure
.
23. We agree to notify CIEE of participant arrivals, failure of any participant to arrive as
expected, performance issues, significant changes to employment terms, if any partici-
pant leaves before his/her scheduled end date, any emergency involving participants, or
any situation that impacts the welfare of participants.
24. The job we are offering is not listed as prohibited by CIEE in the link detailed below—
https://www.ciee.org/partner/employers/work-travel-usa/regulations
.
25. We understand that the student will apply for and obtain a Social Security number
that may not be available at the start of employment. The DS-2019 Form and I-94 card
together will serve as proof of authorization to work.
26. We agree to comply with J-1 Summer Work Travel program regulations, as set forth
in 22 CFR 62.32, available through the U.S. Department of State’s J-1 website
(
http://j1visa.state.gov/sponsors/current/regulations-compliance
), or notify CIEE
immediately of our inability to do so.
27. We will indemnify and hold CIEE harmless against any claims, liability, damages, or costs
incurred by reason of any act, error or omission of the employer or its agents.
Name of person completing this form:
Title:
Signature:
Date
(DD/MM/YYYY)
:
PARTICIPANT SECTION
Name:
Atlas
ID:
Email
address:
Phone:
CIEE
Representative:
Country
of
residence:
TERMS AND CONDITIONS
By signing below, I indicate my understanding and agreement with the following terms:
1. This job offer is not valid until vetted and approved by CIEE. I understand that CIEE is
responsible for vetting employment for program participants and reserves the right to
deny any job offer according to the current and/or anticipated rules, regulations, and
intent of the J-1 Summer Work Travel program. I understand that CIEE must provide writ-
ten approval prior to my starting to work at this company.
2. Any position offered to me is not a firm, irrevocable offer and may be revoked at any time
before I commence employment.
3. In the event that the employer revokes this offer, CIEE will assist me in my effort to find
alternative employment, but CIEE makes no guarantee that its effort will be successful.
4. I will be an employee-at-will, and my employment relationship may be terminated at any
time for any reason as permitted by law by the employer.
5. I fully understand the job offered above. I have reviewed all information related to this
position, as provided to me by the employer, CIEE and/or CIEE Representative.
6. I understand that neither the employer nor CIEE can guarantee the terms of this agree-
ment and that my hours, duties, and housing are subject to change.
7. I will report to the employer listed above within five days of my arrival in the
United States.
8. I will not work outside of the dates listed on my DS-2019 form.
9. I will adhere to all CIEE and CIEE Representative rules regarding employment and pro-
gram participation, including the Terms and Conditions/Participant Declaration that
forms part of my program application.
10. Once I have accepted this job, I am committed to stay at this place of employment for the
duration of the program. If I wish to change employers, I must receive permission from
both CIEE and my CIEE Representative prior to doing so.
11. Should I change jobs without receiving prior permission from CIEE, or if I violate other
CIEE rules, CIEE may terminate its sponsorship of me and I will be required to return
home. I also understand that such termination may prevent me from receiving future U.S.
visas.
12. I agree to adhere to all federal, state and local laws. If I do not do so CIEE may terminate
its
sponsorship of me and I will be required to return home. I also
understand that such ter-
mination may prevent me from receiving future U.S. visas.
Signature:
Date:
Your US employer will need to sign and date this section
You will need to sign and date this section
The following information will be completed by IST Plus