ve ite 3.04320 BEARER IS NOT SUBJECT ‘TWO YEAR RULE DOES vr fetta Sonera Bicccarceremernsce”CIEE Work & Travel USA Job Offer Form: Summer 2017 Fen \aasoveip ma asansoeen CEE Wen Tools mogon US Cpa! ras xaos Ven, ne pen dong opus gutad long sets ane aaransng in pte sony gaol nied Sats. tw sae a ape. possoe agora pind GEE Palen vasa hat prepare my rots a pera tnlornn io ae an ou more eg tm elegeniare scarp To aoa seearatrery fry det iloe youd pont or ern Woh. fave scp corps om ay par neu ory ake. expand feo era ‘his dears fot sesepent The anny a ahem mena meta ent se alr ag ne over automa, nae extn ose AUS ‘Sdbslnathe peor of Sos roarn CEE Wal psa es ompes mrans ta euscrs snes] Sm iVonTaelepam fapee nebo hCG [Pecislnpo toby lee Wrst it, answerer undress aspire Or amar cone eth pone ‘coo hr yam kn spend CEE prnant ons re of any parent teem npc potamares sts sca ares to eterno 2m, Fert inert hanes en cm ny omapny mang Fey oa sn pace mame panegr eb am oe ne Pony Tomine poh yes rx mare date iran tenth Wr 8 Tel UA pg, pee vi wee xghieheri Kg Samer Wi Tere prgen ‘Seatac ry be ease sri CEE = ne eed Chatham Bars Inn 207 Shore Road CChathem, MA 02833 WC! Zurich American Insurance Company WCD194528-00 Male Contact Name: Phone: Email: ‘Job Detal Housekeeper $13.00 Per Hour ‘Average Hours per Week: Housing Provided: NO Work Dates: Thursday, June 15, 2017 Saturday, September 0, 2017 Tee rg, nee my andrea an agent ih long | Tb os en red CEE tread y CEE amare, 2. Ay orm ot atim evecare: bray beste ae bons enporren rt ee alte enp veer bt CCE str ee “THE PARTICIPANT MUST SEND THE ORIGINAL SIGNED AGREEMENT TO THEIR CIEE REPRESENTATIVE “THE PARTICIPANT MUST ALSO SEND A COPY TO THE EMPLOYER AND KEEP A COPY FOR THEIR OWN RECORDS“Confirmation of Insurance Policy Holder Date of bit MemberID: Group Io: Effective Date: 10 June 2017 Termination Dat: 29 October 2017 ‘The health insurance has, within the framework ofthe tariff and insurance conditions, an upper limit for the reimbursement Maximum Benefit, $100,000 Emergency Evacuation: $75,000 Repatriation: $30,000 Emergency Reunion: $15,000 Urgent Travel Expense: $2,000 Copays: $20/ Urgent Care Copay | $50 DocteriSpecialist Copay | $100 ER/Mospital Conay Liabiity Limits: US$-100,000 ‘The insurance coverage expires on the termination dale listed above, or when the participant withdraws from the program, or when they are dismissed from the program, or their employment is terminated, whichever comes fist PROGRAM INFORMATION DS 2019 Number CIEE ATLAS ID Program Code CIEE Partner Code You : insurance coverage Insurance and Program Star Date 10 June 2017 foro api liaise ia ladatic cigal Ele Sat Dat Baus? Dat listed on 05-2018 as ‘Begin date’ of program, You may not start working prior to this date. ‘You must notify CIEE of your address in the US by ths date SEVIS Compliance Deadline 25 June 2017 6F CIEE will terminate your program and you will be fequited to return home jal Employment End Date wnber 2017 | Date listed on DS-2019 as “End date" of program. Youmay not iia hi 80 September 2017 | continue working after ths date Pexeneend Pen Endtele WOdober air ‘You must leave the US by your departure date, Insurance coverage ends on this date. Wy, You ae reed under te group pale ef CIEE fo We pated a a ala ons SOSITON. Per area SO overage posse lr the CIEE webste at wen ve oninaurnce I you have spe queen pases ca CEE of 1-268 208 wT Se aye akon Exchange visitors and any aetna" ‘accompanying spouse and ‘Aetna Student Health dependents), may be subject tothe} SOGRaTTOS LastName requirements of the Afordable Caro} EL Paso, TX 79998 PPO NAP ry Group No. MemberID a; p Spence aN ene (SER age ori i, eo Soro See pal (aden Pert NE OHON LEA psc erties outa eee — Seen fy gut ca aay tiieneontrer Sapeeoann SaarUS. Deparment of State oer (CERTIFICATE OF ELIGIBILITY FOR EXCHANGE VISITOR STATUS Q-NONIMMIGRANT) ——_“STMADAtNDBTME Sin ST aa ion] aaa RT TSE Se a J a rea Cay Ta ——— EP a Sis” _ouivensrey owenotvonte sroomes inc STR RED TES ReROTE tere w stare non 5s Fruwch ice, av 47452-9369 Terao GonnGHD on Tatanational Eavestiona] Eehaage ana TT pts Porm Of Dowritn SUIRER TRAVEL/WORK Tapocianirm Begin new Program) accompanied by nanber (0) of immediate fanily nenbers, Tem oreo Tia Vier ‘ram odpm 06-25-2027 ee ne omy): 09°30-2027 | Sagi i Cae amar ‘Sson02 Fg pit Tad Ra pA OS Be GT [Gs bEPARTENT oF sraTe ns UsE OR CERTINCATION BY ‘Alternate Responsible officer ‘ef Ppa Fa Rae pei Oa i ae Or 02-0272037° “Sir ofan Oi or Alii Repo i “Bae feed Samat ene Otero Raking Senn POR TRANSFER OF PROGEAAY =e = {Stem pestle Tc riya dnc eh Se ern he Man Aina Ce ang Ac wom Sims fap Ofer Akos Reps Oi _ Beate of Seats TAGLAR ENDORSEMENT OF CONSULAR OR IMMIGRATION OFFICER REGARDING SECTION 10 OF TE [BIMCRATON AMD NAMUNALIFY ACY ANDPL Ste ASAMENDED. etna ge Pee aaa Tt Ywo- Veoh WOME RESIDENCE REQLIDGNIEN?) 2 LD siya geen eon 2 renee ering ne 8 [De tecngeie tht ear 6 EO repens os ie i oC op ar pa endianay “TRAVEL VALIDATION BY RESPONSIBLE OFFICER “Wikre tie ing Commend Sommer WearTn (0) Sadar Vc od naga eat ne ‘psi ope ao An epi ew (2) tet Yr podem pene TERCHANGE VISITOR CERTIFICATION: have edad oe wih Be Seine 208 page 20 ida Sign arc Pager?02/0322017 Department of Homeland Security Form I-901 Application Confirmation Student and Exchange Visitor Program: SEVIS 1-901 Payment Confirmation Please print the Payment Confirmation for your records. Reference the confirmation number BBB1712687426 on all inquiries related to ‘your [901 status. You may be required to produce your payment confirmation for your visa issuance, admission to any United States migrant status, or other United States immigration benefits, port of entry, for any change of non ‘When you go to the Consulate for your visa, you should bring your payment confirmation to prove you have paid the SEVIS fee. If you paid by eredit card, this transaction will appear on your eredit card bill as US STUDENT & EV 1901 FEE 800-375-5283 VT Department of Homeland Security US. Immigration and Customs Enforcement Notice of Action UNITED STATES OF AMERICA |CONFIRMATION NUMBER: (CASE TYPE: 1-901 Fee Remittance Form for F-l, F-3, Mel, M-3 and J-l Non Immigrants. PAYMENT DATE: |APPLICANT: [Fob 3, 2017 INAME AND ADDRES: INOTICE TYPI Receipt Notice EMAIL ADDRESS: ‘Your Form I-901 Application and Fee have been received, Please notify us immediately if any of the above information is incorrect. ‘This fee payment is valid only for your particular course of study or program. Ifyou fallout of status, apply for anew F-1,F-3, M-1, M- 3.orJ-1 Nor-immigrant visa, or if you want to chenge your Non-immigrant category to an F-1, F-3, M-1,M-3 or J-1, you may be required to pay another fee, APPLICANT STATUS: J+1 DATE OF BIRTH: PROGRAM NUMBER: EXCHANGE VISITOR CATEGORY: SUMMER WORK/TRAVEL, AMOUNT RECEIVED: SEVIS IDENTIFICATION NUMBEI ‘THIS ELECTRONIC RECEIPT SHALL BE USED AS EVIDENCE OF PAYMENT 1-901 StudenvExchange Visitor Processing Fee lp.0. Box 970020 St, Louis, MO 63197-0020 Customer Service Telephone 703-603-3400,WORK & TRAVEL USA PR