Student Information:
On Campus Employment Form
Family Name:
Given Name:
Email Address:
Employment Information:
Job Title:
Department Name:
Supervisor Name:
Phone Number: (
) -
, or Ext.
Start Date:
End Date:
_/ /20_ , or Not Applicable
Number of Scheduled Hours: hours per week
Acknowledgement Information:
To meet the requirements as an F-1 International Student at Loma Linda University (LLU), I,
, agree that:
Student Given Name and Family Name
1. I will not exceed more than twenty (20) hours per week of paid labor during the academic year.
2. I will not exceed more than forty (40) hours per week of paid labor during designated university
term breaks (i.e. Winter break, Spring break, and Summer break).
3. I will work with my supervisor to ensure that I do not exceed the maximum hours per week, as
stated in the USCIS regulations.
4. I will notify the International Student & Scholar Services office if there are any changes in my
employment or if I have any additional jobs on campus to report.
5. I am no longer eligible to work on campus if I am not enrolled as an Loma Linda University
student or if my F-1 visa is terminated or canceled for any reason.
I understand that failure to meet any of the above requirements may result in termination of my
I-20 and F-1 immigration status at Loma Linda University.
Student Signature
Date ISSS Advisor
click to sign
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