OPT Participants: Employment Request

First Name

Last Name

Pacific ID Number

SEVIS Number

Employer/Company Name

Employer Identification Number (EIN)

Street Address

City

State

Zip Code

Supervisor's Name

Supervisor's Title

Supervisor's Phone Number

Supervisor's Email

Previous/Current Position Employment End Date

New Position Employment Start Date

Employment Type

Job Title

Explain how the employment is related to your major

Please attach a copy of your EAD card (front and back) and offer letter.