Work & Travel Employment Agreement



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WORK & TRAV

WORK & TRAVEL USA WORK & TRAVEL USA

WT-PA051-1012  

Page 1 of 2

WORK & TRAVEL USA

Employment Offer and Agreement

  EMPLOYER SECTION:  



(TO BE COMPLETED BY BUSINESS OWNER OR AUTHORIZED REPRESENTATIVE) 

Position Offered To :

from

FIRST NAME



MIDDLE NAME

FAMILY NAME

STUDENT'S COUNTRY

Legal Business Name:

Doing Business As:

Corporate/Main Address:

STREET

CITY


STATE

ZIP


Employment Location:

ADDRESS WHERE STUDENT WILL WORK, IF DIFFERENT FROM ABOVE

CITY

STATE


ZIP

Type of Business:

Website:

Federal Tax ID#:

Worker's Comp Policy:

POLICY NUMBER (IF REQUIRED BY STATE LAW)

CARRIER

Employment Contact:



Business Owner:

NAME


NAME

TITLE


TITLE

PHONE


PHONE

MOBILE


MOBILE

EMAIL


EMAIL

Student Position:

 

Yes


    

No

JOB TITLE



WAGE PER HOUR

TIPPED POSITION?

START DATE (MMDDYYY)

END DATE (MMDDYYY)

Average number of work hours per week:

Are overtime hours available?

 

Yes


    

No 


   

Maybe


Total # of international students hired at this location:

Total # of All Employees:

Total # of international students from InterExchange:

Total # hired from other sources:

Which other sponsor companies are you using to provide seasonal help?

What level of English is required for this position?     Beginner         Conversational          Fluent

Please describe job duties:

Please describe any deductions from student paycheck:

Is housing provided ?   

Yes   No


Deposit Amount:

Cost: $


Per   Week    Month

(DURATION)

Approximate # of Students per Room and description of housing:

Is transportation available?  Yes   No

Distance from job location:

What opportunities will the participant have to experience American culture while in your employ?

  EMPLOYER AND EMPLOYEE SECTION ON NEXT PAGE: Employer and employee must read and sign Page Two



IMPORTANT: An InterExchange representative will contact the employer at the place of business to verify employment offer and the information on this agreement.

Without confirmation of this offer and agreement, InterExchange will be unable to provide sponsorship to the prospective employee.

InterExchange, Inc is a designated J-1 Visa sponsor for the U.S. Department of State regulated Summer Work Travel Program (22C.F.R. Part 62). Participant sponsorship 

is not granted until this Employment Offer and Agreement has been received, reviewed and approved by an authorized InterExchange representative. Continued 

sponsorship is contingent upon the successful execution of and adherence to this agreement between the employer and named international exchange student. Please 

be advised that as per U.S. Department of State regulations, a representative of the J-1 Visa program may also contact employers regarding this job offer.




WORK & TRAV

WORK & TRAVEL USA WORK & TRAVEL USA

WT-PA051-1012  

Page 2 of 2

WORK & TRAVEL USA  Employment Offer and Agreement

  EMPLOYER SECTION: 



(CONTINUED. TO BE COMPLETED BY EMPLOYER)

The undersigned Employer agrees to the following terms and conditions:

I agree to adhere to the goals, objectives, government regulations and sponsor guidelines 

of the J-1 Summer Work Travel Exchange Visitor Program (22C.F.R. Part 62).

By completing and signing this agreement I affirm that the student named above has 

been offered temporary employment with the business named herein and that terms 

stated in this Offer and Agreement are true to the best of my knowledge.

I certify and attest that I am authorized to extend this employment offer to the student on 

behalf of the company stated herein.

I affirm that my company is none of the following: a staffing or employment agency, 

home-based, adult entertainment, travelling fair, itinerant concessionaire, chemical pest 

control, a warehouse, a catalogue/online order distribution center, pedicab, rolling chair 

or door-to-door sales enterprise; and further, agree that the position does not engage 

the student in childcare, health/clinical care or domestic services of any kind, require 

investment of funds for inventory or that are substantially commission-based, require 

a driver's licenses, require work hours that fall predominantly between 10:00 pm and 

6:00 am, is not declared hazardous to youth by the Secretary of Labor at Subpart E of 

29 CFR part 570, require sustained physical contact with other people and/or adherence 

to the Centers for Disease Control and Prevention’s Universal Blood and Body Fluid 

Precautions guidelines (e.g., body piercing, tattooing, massage, manicure), is not involved 

in gaming and gambling that include direct participation in wagering and/or betting, is 

not in the North American Industry Classification System’s (NAICS) Goods-Producing 

Industries occupational categories industry sectors 11, 21, 23, 31–33 numbers (set forth at 

http://www.bls.gov/iag/tgs/iag_index_naics.htm), does not fall within another specific J 

category (e.g., camp counselor, intern, trainee), or any position that could bring notoriety 

or disrepute to the U.S. Department of State Exchange Visitor Program.  

I affirm that this position is seasonal or temporary in nature, that my company has not 

experienced layoffs in the past 120 days, does not currently have workers on lockout or 

on strike and will not displace U.S. workers at the worksite listed on this form and that this 

position will provide opportunities for regular communication and interaction with U.S. 

citizens and allow participants to experience U.S. culture.

I understand that InterExchange is the U.S. Department of State designated sponsor of 

the Summer Work Travel J-1 Visa program and the sponsor may at any time withdraw 

sponsorship from any participant in the event of non-compliance with the program 

regulations.

I attest that the relationship between the employer and student will comply with all 

Federal, State and Local laws regarding employment and occupational health and safety.

I attest that the position is available for the student for the entire employment period 

stated herein although conditions of employment may change due to unavoidable 

circumstances beyond my control. I further agree to notify InterExchange immediately 

if any of the terms of this offer change, if the student leaves or is terminated from the 

position or suffers any medical, psychological or criminal adverse effect.

I understand that the maximum duration for employment is 4 months (12 months for 

Australian and New Zealand students) as pertains to the dates stated on the student’s 

DS-2019 form.

I understand that all students participating on the U.S. government regulated Summer 

Work Travel program are made aware of Federal Minimum Wage laws. I hereby agree to 

pay international students in accordance with minimum wage standards, but not less than 

what is customary for U.S. residents holding the same job.

Per IRS Employer Tax Guide and Publication 515, I understand that students on a J-1 

Visa are considered non-resident aliens who are not subject to Social Security (FICA), 

Medicare or Federal Unemployment (FUTA) withholding taxes. I agree to consult a tax 

professional regarding state unemployment tax exemptions within my state.

I understand that the student will apply for and obtain a Social Security number that may 

not be available at start of employment. The DS-2019 form and I-94 card together will 

provide proof of authorization to work.

I agree to obtain advance permission in writing from the student for any payroll deductions 

or changes to deductions. 

I certify that the employer maintains and extends Worker’s Compensation coverage to 

employees if mandated by state law at student’s work site.

If I agree to provide or assist in securing housing for the student I agree to provide housing 

that is safe, appropriate and compliant with all housing codes at reasonable cost and 

terms. Further, I understand that InterExchange is not responsible for paying housing 

deposits or costs.

I understand and agree that InterExchange cannot be held liable for the performance of 

the participant, nor for any civil or criminal liability incurred by the participant (including 

defense costs). Further, I understand that InterExchange cannot guarantee continuous 

employment coverage in the event student leaves position or is terminated.

I will indemnify and hold InterExchange harmless against any claims, liability, damages 

or costs incurred by reason of any act, error or omission of the employer or its agents.

I agree that any controversy, dispute or claim arising out of or in connection with 

this agreement, the relationship of the parties, or its interpretation, performance 

or nonperformance, or any breach thereof shall be determined solely in arbitration 

conducted in New York, NY in accordance with the then existing rules of the American 

Arbitration Association.

The U.S. Department of State Summer Work Travel regulations can be found by visiting 

the following website: j1visa.state.gov/wp-content/uploads/2012/05/2012- swt-ifr.pdf

SIGNATURE OF AUTHORIZED COMPANY REPRESENTATIVE 

Upon completion please return this form and any accompanying paperwork to the student. InterExchange must receive the completed Agreement from the student as part of their 

sponsorship application. InterExchange will contact you to obtain and verify your Federal Tax ID (EIN), a copy of the cover page/deck sheet of your workers’ compensation policy 

and a copy of your business license or proof of current registration with the city or state in which your business is located.

NAME OF EMPLOYER (PRINT)

TITLE

SIGNATURE



DATE (MM/DD/YYYY)

  EMPLOYEE SECTION: 



(TO BE COMPLETED BY STUDENT SEEKING J-1 VISA SPONSORSHIP)

STUDENT Terms

I hereby acknowledge that I have reviewed, understand and agree to all the terms 

of this job offer.

I understand that InterExchange may find this job offer unacceptable and I will not 

be allowed to pursue employment with this company.

I agree to work 4 months or less in total (12 months for Australian and New Zealand 

students), and until the last date stated above. 

I understand that neither my employer nor InterExchange can guarantee the terms 

of this offer and that my duties and responsibilities are subject to change according 

to the needs of the employer or other unforeseen circumstances. I understand that 

the average number of hours per week is an estimate and is subject to change 

according to the needs of the employer.

I agree to hold my employer and InterExchange harmless for any financial loss 

sustained by me as a result of the change in terms of this employment offer. I 

understand that either I or my employer may terminate the employment 

relationship at any time with or without prior notice according to applicable 

employment laws.

I agree to notify InterExchange immediately if I am terminated from this position. 

I further understand that failure to notify InterExchange of any change of 

employment or housing within one week may result in automatic termination from 

the program.

I understand that I must inform InterExchange of my intention to leave this 

employer and will not begin work at a new job prior to verification and consent 

by InterExchange.

I understand that I may be responsible for securing housing on my own before or 

upon arrival if it has not been included in this offer.

I have read, understand and agree to the paycheck deductions and further 

understand they may be subject to change. Further I understand that a separate 

agreement may be required for housing and transportation if provided by the 

employer.

I understand that it may take up to two weeks to receive my first paycheck and 

have adequate funds to support myself during this time. 

In addition, by signing below, I am acknowledging that I have found this job 

through my own means and have not purchased this job offer from a third party.

 

SIGNATURE OF EMPLOYEE/STUDENT



NAME OF EMPLOYEE (PRINT)

SIGNATURE

DATE (MM/DD/YYYY)

NAME OF LOCAL AGENT 

NAME OF UNIVERSITY 

International Exchange Center



Document Outline

  • work-employment-agreement
  • WT-PA05-0211 Employment Agreement-working.pdf
  • Blank Page

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