PERSONAL INFORMATION

(All the details must be valid)

Name of the Participant:
(as appears on the passport)

Street Address, City, Country:

Telephone number:

Email Address, Skype:

Date of Birth:

EDUCATION
Name of The University:

Graduation Date:

Type of Degree:

Major Field of Study:

Relevant Courses Taken:

SKILLS and MISCELLANEOUS INFORMATION

Why are you interested in
participating on J-1 Internship
program?

Other Languages:

English Ability

Have you ever visited the

United States:
Have you ever worked in the
United States?
Do you have a driver’s license?

Hobbies:

PROFESSIONAL EXPERIENCE 1
Company:

Job Title:

City, Country:
Dates:

Brief Description of Task and

Responsibilities:

PROFESSIONAL EXPERIENCE 2
Company:

Job Title:

City, Country:

Dates:

Brief Description of Task and

Responsibilities:

PROFESSIONAL EXPERIENCE 3
Company:

Job Title:

City, Country:

Dates:

Brief Description of Task and

Responsibilities: