1765 Stadium Road, 170 HUB
Gainesville, FL 32611-3225
The Foundation for The Gator Nation
Rev. Jun-16
An Equal Opportunity Institution
Previous Employment Information
If you were previously employed, provide the following information about the previous employer/company. Please note this
only applies to employment during the time you have been on OPT or STEM OPT.
Employer/Company Name: ______________________________________________________________________________________
(If employed by a university, please list name of university as well as name of department)
Employment/Job Start Date: _____________________________ (Please provide the date you started your previous job)
Employment/Job End Date: _____________________________ (Please provide the date you last worked at previous job)
Hours per Week: ______________________ (numeric data only: 0-9 and decimal point)
Explain how employment is directly related to your major filed/course of study:
Describe 3-5 of your job duties and explain how the employment is directly related to your major field of study.
Maximum of 1000 characters; aim for 3-4 sentences, provided in paragraph style rather than list/bullet points. This
description is exactly what will be entered into your SEVIS record; please use the appropriate level of formality. (PLEASE
NOTE that SEVIS will not allow us to use more than 1000 characters).
Updated I-20 Request:
Reporting your employment and home address does NOT automatically require you to receive an updated I-20.
Please refer to the Travel Endorsement section of your current I-20 for the Travel Signature. The Travel Signature is valid
for six months from the date next to the signature. (i.e. if it was signed March 1, 2016, it is valid through August 31,
2016.) If you are travelling out of the US and will return after the travel signature expires, please request an updated
travel signature at least two – four weeks prior to your expected travel departure date.
If you previously worked at Company A, and your I-20 reflects Company A’s information in the Remarks section on page
one or the Employer Information section on page two, and now you work at or are changing employers to Company B,
you may request an updated I-20 along with providing an updated OPT report. If no employer information is indicated
on the I-20, a change in employer while on OPT does not necessarily need to be indicated on the I-20.
Do you need an updated I-20 as a result of this OPT report? NO YES
If you request a new I-20, you will receive an email when it is ready for pick up or mailing. Please allow 5-7 business days.
Please Note: This I-20 cannot be used to apply for STEM Extension OPT. Please read the instructions listed
here if you would like to apply for STEM OPT. If you have any questions, please contact your specific F-1 Advisor.
Acknowledgment:
By submitting this OPT reporting form, you confirm all of the information provided above is true and accurate, all work
which you do is directly related to your major field of study, you work 20 hours or more per week (even if through multiple
employers), and you understand you cannot exceed 90 cumulative days of unemployment throughout the Standard OPT.
Also, if you are on STEM OPT, your employment is only with E-Verified Employers and you understand you cannot exceed an
additional 60 cumulative days of unemployment.
Please type your name to acknowledging reading and acceptance of the above: _______________________________________
