Fillable I-765 0 (Henry Ford College)

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I-765 0 (Henry Ford College)

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The I-765 0 (Henry Ford College) form is 1 page long and contains:

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  • 11 check-boxes
  • 28 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Henry Ford College

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Approved
OMB No. 1615-0040; Expires 08/31/08
Remarks
A#
Applicant is filing under §274a.12
Fee Stamp
Action Block
(Date).
until
(Date).
Subject to the following conditions:
Application Denied.
Failed to establish eligibility under 8 CFR 274a.12 (a) or (c).
Failed to establish economic necessity as required in 8 CFR 274a.12(c)(14), (18) and 8 CFR 214.2(f)
Permission to accept employment.
I am applying for:
11. Have you ever before applied for employment authorization from USCIS?
(Middle)
No
Yes (If yes, complete below)
Date(s)
2. Other Names Used (Include Maiden Name)
(Apt. Number)
3. Address in the United States (Number and Street)
12. Date of Last Entry into the U.S. (mm/dd/yyyy)
(ZIP Code)
(State/Country)
(Town or City)
13. Place of Last Entry into the U.S.
4. Country of Citizenship/Nationality
14. Manner of Last Entry (Visitor, Student, etc.)
(Country)
5. Place of Birth (Town or City) (State/Province)
15. Current Immigration Status (Visitor, Student, etc.)
7. Gender
6. Date of Birth (mm/dd/yyyy)
Female
Male
16. Go to Part 2 of the Instructions, Eligibility Categories. In the space below, place
the letter and number of the category you selected from the instructions (For
example, (a)(8), (c)(17)(iii), etc.).
Married
Single
Divorced
Widowed
9. Social Security Number (Include all numbers you have ever used) (if any)
Eligibility under 8 CFR 274a.12
10. Alien Registration Number (A-Number) or I-94 Number (if any)
) (
(
Your Certification: I certify, under penalty of perjury under the laws of the United States of America, that the foregoing is true and
correct. Furthermore, I authorize the release of any information that the U.S. Citizenship and Immigration Services needs to determine
eligibility for the benefit I am seeking. I have read the Instructions in Part 2 and have identified the appropriate eligibility category in
Block 16.
Date
Signature
Signature of person preparing form, if other than above: I declare that this document was prepared by me at the
request of the applicant and is based on all information of which I have any knowledge.
Date
Address
Signature
Print Name
Relocated
Resubmitted
Completed
Initial Receipt
Rec'd
Sent
Denied
Returned
) (
)
Which USCIS Office?
Results (Granted or Denied - attach all documentation)
Telephone Number
8. Marital Status
Do not write in this block.
I-765, Application for
Employment Authorization
1. Name (Family Name in CAPS) (First)
Certification.
Department of Homeland Security
U.S. Citizenship and Immigration Services
Remarks
Replacement (of lost employment authorization document)
Renewal of my permission to accept employment (attach previous employment authorization document).
Form I-765 (Rev.07/30/07) Y
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I-765 0 (Henry Ford College)

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Completed 17 September 2020

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