STATE OF NORTH CAROLINA

COUNTY OF BUNCOMBE

PETITION FOR ALIEN WORKER AGREEMENT

This PETITION FOR ALIEN WORKER AGREEMENT, made and entered into this the _____ day of

_______________200____, by and between Aston Park Health Care Center, Inc., hereinafter called “Facility” and

____________________________________________________, hereinafter called “Alien Worker” and

____________________________________________________, hereinafter called “U.S. resident, Sponsor”.

WITNESSETH:

In consideration of the mutual covenants herein contained, and intending to be legally bound hereby, the parties

hereto agree as follows:

1. In consideration for facility paying the lawyer to file an immigrant VISA for above named alien worker.

Alien worker is bound to assist with providing the proper paperwork, credentials, school transcriptions, and

other documents as required for the processing of the immigrant VISA.

2. Alien worker also agrees not to file a petition for any type of VISA with any other petitioner.

3. Alien worker understands that they must also sign an employment agreement with the petitioner to agree to

work for a (2) year term with the organization starting on the date Alien Worker receives his/her North

Carolina registered nurse licenses.

4. Facility agrees to continue the petitioning process until the completion and offer alien worker a position at

the facility in the United States upon Alien worker’s receipt of immigrant VISA.

5. Both parties understand that all petitions have to be approved by the US Embassy and the Philippine

Consulate. Thus, facility and employee will provide all information and file all documents in compliance

with the US Embassy. Employee and facility agree that the US Embassy will make the ultimate decision as

to whether or not the VISA is granted.

6. Facility agrees to reimburse Alien Worker for the following items upon the start of their official

employment with Aston Park Health Care Center provided the Alien worker provides a legitimate receipt

for the expense: Filing of the petition for the immigrant VISA, Airline ticket from the Philippines to the

United States, (1) NCLEX application and exam fee, VISA screen fee, and the fee for the medical exam

required prior to traveling to the United States. All other expenses will be the responsibility of the Alien

Worker.

7. This agreement shall be interpreted and construed according to the laws of the State of North

Carolina.

8. If Alien Worker does not fulfil this agreement, Alien Worker or U.S. Resident Sponsor will repay to Aston

Park Health Care Center the total amount of the lawyer fee to file said petition. Lawyer fee for this petition

is $_____________.
In witness whereof, the Facility has caused this Agreement to be executed in duplicate originals and its corporate

name to be affixed by it duly authorized officers pursuant to authority duly given by the Board of Trustees. In

further witness whereof the authorized officer and Alien Worker have set their hand and seal, all as of the day and

year first written above.

IN WITNESS WHEREOF, the parties have hereunto set their hands and seals in duplicate counterparts, each of

which shall constitute an original, the day and year first above written.

ASTON PARK HEALTH CARE CENTER, INC.

BY:_____________________________________ DATE:________________

TITLE: Executive Director

I HEREBY CERTIFY that on this day before me, an officer authorized to administer oaths and take

acknowledgements, personally appeared Marsha W. Kaufman who, after being sworn and cautioned, upon

oath given by me, executed the foregoing instrument and acknowledged that he/she executed said instrument for

the purposes therein expressed.

____________________________________

Notary Public

SEAL

My Commission Expires: ______________

________________________________________ DATE:________________

Alien Worker

COUNTY OF ___________________________
 I HEREBY CERTIFY that on this day before me, an officer authorized to administer oath and take

acknowledgements, personally appeared ________________________________who, after being sworn and

cautioned, upon oath given by me, executed the foregoing instrument and acknowledged that he/she executed

said instrument for the purposes therein expressed.

_________________________________________

Notary Public

SEAL

{ } Personally Known or { } Produced Identification____________________________________

_____________________________________

U.S. Resident – Co-signer for Alien Worker

COUNTY OF ___________________________

I HEREBY CERTIFY that on this day before me, an officer authorized to administer oath and take

acknowledgements, personally appeared ________________________________who, after being sworn and

cautioned, upon oath given by me, executed the foregoing instrument and acknowledged that he/she executed

said instrument for the purposes therein expressed.

_________________________________________

Notary Public

SEAL

{ } Personally Known or { } Produced Identification____________________________________

 DOCUMENTS REQUIRED TO FILE THE 1-140

PETITION

Each Nurse applicant should provide the following information and good-quality copies of the following

materials for themselves and each immediate family member, where applicable:

E-Mail Address/Mailing Address;

Telephone Number;

Passport Biographic Page;

Curriculum Vitae listing each employer, employer address, dates of employment, Name/title of supervisor and

telephone number;

Birth Certificate, Certified Copy;

Marriage Certificate, Certified Copy;

Certified Birth Certificate for spouse and each child;

Bachelor of Science Degree/Transcript;

Registered Nurse License;

Test of English as a Foreign Language (TOEFL);

CGFNS Examination Certificate;

Visa Screen Certificate;

Police Certificates issued by the National Bureau of Investigation (NBI); and

Completed DS 230 Part I/II Applications for Immigrant Visas, to be completed and signed by primary applicant and

immediate family member(s).

Employee Agreement – signed and notarized.