Country of Citizenship: _________________________________
Social Security Verification Form
University of Wisconsin-Parkside
Please return this form to:
UW-Parkside International Student Services
900 Wood Road
Kenosha, WI 53144 USA
t Park
To be Completed by Student
To be Completed by Hiring Ocial
Student Name: _______________________________________
Employing Department/Contractor: _______________________________________________________________________________
Employer Identification Number (required): __________________
Hiring Ocial Name: ___________________________________
Signature: ___________________________________________
Title: _______________________________________________
Date: _______________________
Street Adress:____________________________________ Zip Code:____________
Immediate Supervisor Name: ________________________
Beginning Date:_____________________
Please attach job description
This is to serve as notif
ication that the student listed above has been oered employment.
I understand that F-1 and J-1 students are not eligible to work more than 20 hours per week while school is in session. Full-time employment may
permitted during vacation periods, if the student intends to register the subsequent semester.
To be Completed by International Student Advisor
I have verified that this student is enrolled full-time, has been registered in SEVIS and is therefore eligible to accept employment at the University
of Wisconsin Parkside.
Signature: ____________________________________________
International Student Advisor, Designated School Ocial
Date: _______________________
(Print form on Company/Dept. letterhead)
Email: __________________________
Ending Date:_____________________
Phone: _______________
I confirm I have:
Updated my local mailing adress in Solar Registered full-time
UWP Student ID#: _ _ _ _ _ _ _ _ _
SEVIS#: N _____________________________
Email: _________________________@rangers.uwp.edu Visa type: F-1 J-1
(Last) (First)
is an F-1 Student enrolled or employed at the University of Wisconsin-Parkside and is eligible to accept employment in the following category:
On-Campus Employment
O-Campus Curricular Practical Training (CPT)
O-Campus-Optional Practical Training (OPT)
J-1 Scholar