Program Office
Resume:
PPROGRAM APPLICATION GUIDE
**** *** **** *** ****** Program
THIS IS YOUR COPY. DO NOT SUBMIT THIS TO FPI
STEPS WHAT TO DO
ORIENTATION Applicant must attend the orientation conducted by FPI together with parent or guardian.
APPLICANT – a student who is interested to join the program
Orientations will be held either at your school or at FPI offices in Manila and Cebu.
PRE
APPLICATION
FORM
Applicant must create official FPI Email Account through Gmail
(https://mail.google.com/) using this format:
PROFILING
FEE
PAYMENT
Applicant can pay the NON REFUNDABLE Profiling fee of Php 5,750 at FPI BDO Account:
Bank Name:
BDO (Banco De Oro)
Account Name:
First Place Inc.
Peso Savings Account:
Write down your full name and cell phone number on the deposit slip. Using your FPI Gmail account, send a scanned copy of the deposit slip to: ac1pjp@r.postjobfree.com for recording.
Reference Number for BDO deposit: FirstNameMiddleNameLastName
(example: JUANPAOLODIZONDELACRUZ)
EMAIL SUBJECT LINE: 5750 – (Applicant’s Name)
(example: 5750 – Juan Paolo Dela Cruz)
FPI STUDENT
PORTAL
After your payment has been recorded, your FPI Student Portal username and password will be sent to your FPI Gmail Account.
Go to www.firstplaceinc.org/portal_login ; enter your username and password and complete your Personal Information.
APPLICATION
KIT – PART 1
You can get your APPLICATION KIT – PART 1 by:
a) Getting it from FPI Office (Manila or Cebu)
b) Through your school coordinator
c) Downloading it from your FPI Student Portal – by downloading the application kit – part 1, the applicant fully understand, agree and comply with the requirements of the program.
Present a copy of your Php 5,750 when claiming your application kit – part 1 at FPI Office (Manila/Cebu) or to your school coordinators. CHECKLIST
PAYMENTS:
Profiling fee
(Php 5,750)
DOCUMENTS:
Create FPI Gmail
Account
Scan and email
Php 5,750 receipt
Complete your FPI
Student Portal
(Personal Details)
Get Application Kit
– Part 1
ac1pjp@r.postjobfree.com
(example: ac1pjp@r.postjobfree.com)
GET PROFILED/ASSESSED
Send FPI a ‘TEST MAIL’ for us to know immediately your created FPI Gmail Account. Send ‘TEST MAIL’ to: ac1pjp@r.postjobfree.com EMAIL SUBJECT LINE: Test Mail (Applicant’s Name)
DEADLINE:
After attending
Orientation
PROGRAM APPLICATION GUIDE
2017 USA Work and Travel Program
THIS IS YOUR COPY. DO NOT SUBMIT THIS TO FPI
STEPS WHAT TO DO
SUBMISSION OF
APPLICATION
KIT – PART 1
REQUIREMENTS
Submit the following APPLICATION KIT – PART 1 REQUIREMENTS in a SHORT BROWN ENVELOPE:
WAT Form 1 (Declaration of Acceptance of Procedure) – signed by applicant and parents
WAT Form 2 (Program Application Form) – attached 2x2 photo WAT Form 3 (Program Terms and Conditions) – signed by applicant and two (2) parents or (2) legal guardians and MUST BE NOTARIZED
Photocopies of one (1) valid IDs of Parents/Legal Guardian – such as:
Postal ID
Driver's License
Valid Passport
SSS/GSIS card
NBI Clearance or Police Clearance
(2) Photocopies of Passport Information Page – valid until January 2018;
IF NOT VALID – renew your passport immediately
IF PASSPORT IS NOT YET AVAILABLE – submit a copy of DFA receipt or proof of application.
(1) Original School Certificate
Resume with 2x2 Photo (formal and white background) – see sample format
KEEP EXTRA COPIES OF ALL THE DOCUMENTS YOU WILL BE SUBMITTING.
INITIAL
PROGRAM FEE
PAYMENT
( $ 500 )
Pay your INITIAL PROGRAM FEE of $500
BDO (Banco De Oro)
First Place Inc.
Dollar Savings Account
*REFUND PROCESSING FEE OF $50.00 FOR THE APPLICANTS WHO PAY THE DEPOSIT OF
$500.00 AND DECIDE NOT TO PURSUE THEIR APPLICATIONS. NO PESO PAYMENT WILL BE ACCEPTED!
(Bank handling fee of Php 500.00 for erroneous peso payments to cover dollar fees to be deposited back to applicant’s account)
Write down your full name and cell phone number on the deposit slip. Using your FPI Gmail account; send a scanned copy of the deposit slip to: ac1pjp@r.postjobfree.com for recording.
EMAIL SUBJECT LINE: $500 – (Applicant’s Name)
(example: $500 – Juan Paolo Dela Cruz)
APPLICATION
NUMBER
After submission of COMPLETE Application Kit – Part 1 requirements and payment of initial program fee you will be given Application Number that entitles you to be lined up for a Job Interview.
Completion Number will be issued after we receive your complete documents before 3PM on your FPI Student Portal on the next day. CHECKLIST
PAYMENTS:
Initial Program
fee ($500)
DOCUMENTS:
Scan and email
$500 receipt
WAT Form 1
WAT Form 2
WAT Form 3 –
NOTARIZED
Photocopies of at
least one (1) valid
IDs of BOTH
Parents/Legal
Guardian
(2) Passport
Copies
(valid until January 2018)
OR Copy of DFA
Receipt
(Proof of application)
(1) Original School
Certificate
Resume with
Photo
GET STARTED
DEADLINE:
2 weeks after
payment of Profiling
Fee (Php 5,750)
PROGRAM APPLICATION GUIDE
2017 USA Work and Travel Program
THIS IS YOUR COPY. DO NOT SUBMIT THIS TO FPI
STEPS WHAT TO DO
PRE HIRING
REQUIREMENTS
Submit the following before scheduled General Assembly:
Original Police Clearance or NBI Valid for Travel Abroad
WAT Form 4 (Health Questionnaire) – All items must be answered accurately and attached the following:
o Copy of Chest X-ray Result
o Copy of Personality Test conducted by First Place / School Counselor / Accredited Provider
WAT Form 5 (Return Guarantee Agreement / RGA)
o Completely filled out form and notarized
o RGA Form should be signed by your father, mother PLUS two (2) other guarantors aside from your parents. o In case either or both of your parents cannot sign the forms for any reasons, call FPI for further instructions. o Guarantors MUST be of legal age, residents of the Philippines and have valid government-issued IDs such as:
Postal ID
Driver's License
Valid Passport
SSS card
NBI Clearance or Police Clearance
o Both parents or legal guardian PLUS two (2) guarantors must submit ANY Proof of Income such as:
Latest Income Tax Returns
Certificate of Employment
Bank documents – Last 3 months Bank Statement,
Certificate or Passbook
Business Permit
Certified true copy of Land Title (TCT)
Photocopies of at least one (1) valid government-issued IDs – for both parents/legal guardian(s) PLUS two guarantors
Photocopies of ANY Proof of Income – for both parents/legal guardian(s) PLUS two guarantors
GENERAL
ASSEMBLY
You are required to attend a General Assembly with your parents or legal guardian to prepare for the upcoming Hiring Events (Job Interview)
Date, time and venue to be announced through your FPI Gmail and FPI Student Portal
HIRING EVENTS
(JOB INTERVIEWS)
Attend your scheduled hiring event that can either be in person or virtual (via SKYPE).
Date, time and venue to be announced through your FPI Gmail.
Prepare for the interview. Research about your company
Sign Job Offer as soon it is available.
PROGRAM
BALANCE
PAYMENT
Pay your PROGRAM BALANCE of $1,045 at any of FPI’s accredited banks
– see Step 2 (Get Started)
NO PESO PAYMENT WILL BE ACCEPTED!
(Bank handling fee of Php 500.00 for erroneous peso payments to cover dollar fees to be deposited back to applicant’s account)
Write down your full name and cell phone number on the deposit slip. Using your FPI Gmail account, send a scanned copy of the deposit slip to: ac1pjp@r.postjobfree.com for recording.
EMAIL SUBJECT LINE: $1045 – (Applicant’s Name)
(example: $1045 – Juan Paolo Dela Cruz)
CHECKLIST
PAYMENTS:
Program Balance
($1,045)
DOCUMENTS:
Scan and email
$1,045 receipt
Original Police
Clearance or NBI
WAT Form 4
Chest X-ray Result
Personality Test
Result
WAT Form 5 –
notarized and
accomplished
Copy of one (1)
valid ID of your
both parents or (2)
legal guardians
PLUS two (2)
guarantors
Proof of Income of
Parents/Legal
Guardians and (2)
Guarantors
GET HIRED
DEADLINE:
2 weeks before
Hiring Event
(Placement Interview)
PROGRAM APPLICATION GUIDE
2017 USA Work and Travel Program
THIS IS YOUR COPY. DO NOT SUBMIT THIS TO FPI
STEPS WHAT TO DO
US SPONSOR
APPLICATION
KIT – PART 2
Get your Application Kit – Part 2 Requirements right after the Hiring Event (Job Interview) or it will be emailed to you if you have been interviewed via SKYPE.
Proof of Enrollment (2nd Semester)
You must be able to complete all 2nd set of requirements for SEVIS Number and DS2019 processing.
SEVIS NUMBER (Student and Exchange Visitor Information System) It is a nationwide, Internet-based system that the U.S. government uses to maintain accurate and current information on non-immigrant students exchange visitors (J visa).
DS2019 FORM (Certificate of Eligibility for Exchange Visitor Status) document used in the administration of the exchange visitor program. This form permits the applicant to seek an interview at U.S. embassy
BATCHING (Processing of SEVIS number and DS2019) will take 2-3 weeks upon completion of all 2nd set of required documents.
VISA PAYMENT
Before going to the bank, you must print the applicable U.S. visa application deposit slip via http://www.ustraveldocs.com/ph/ph-niv- paymentinfo.asp#options
Click ‘Fee Payment Options’ then click ‘Deposit Slip - $160 MRV Fee’
Take the printed deposit slip with you to pay at ANY branch of BANK OF PHILIPPINE ISLANDS (BPI) – DO NOT PAY THIS TO FPI ACCOUNT WARNING: Only ONE student can use the US Visa Receipt Number
After paying, write your full name and cellphone number on the deposit slip. Using the FPI Gmail account; send a scanned copy of the deposit slip to ac1pjp@r.postjobfree.com for recording.
EMAIL SUBJECT LINE: VISA FEE PAYMENT – (Applicant’s Name)
(example: Visa Fee – Juan Paolo Dela Cruz)
VISA BRIEFING
and INITIAL
CHECKING
(Date to be scheduled)
Attend visa briefing to be conducted by FPI, together with parent or legal guardian.
DS-160 ONLINE
APPLICATION
After receiving your SEVIS number through your FPI Student portal, applicant will now fill up the DS-160 (US Visa Online Application) – instructions List to follow.
DS-160 is only the first step in the visa application process.
FINAL VISA
BRIEFING
(Date to be scheduled)
Attend FINAL visa briefing. Bring the following documents for checking:
List of Grades
Parent/Legal Guardian’s Proof
of Income
2x2 Photo
Original Passport
(1) Original School Certificate
& Proof of Enrollment Signed Job Offer
ACTUAL VISA
INTERVIEW AT
US EMBASSY
(Date to be scheduled)
Attend your scheduled J-1 (Exchange Visitor) Visa Interview with a consul at the US Embassy in Manila.
After the interview, you MUST report to FPI Office in Manila for your passport delivery arrangements and debriefing process
CHECKLIST
PAYMENTS:
Visa Payment
($160 in PESO
EQUIVALENT)
DOCUMENTS:
Scan and email
Visa Payment
receipt
US Sponsor
Application Kit –
Part 2
Requirements
(Refer of Kit Part 2)
(1) Copy of Proof
of Enrollment
GET VISA
DEADLINE:
10 days after
Hiring Event
(Placement Interview)
PROGRAM APPLICATION GUIDE
2017 USA Work and Travel Program
THIS IS YOUR COPY. DO NOT SUBMIT THIS TO FPI
STEPS WHAT TO DO
FINAL TRAVEL
ARRANGEMENT
Make Final Arrangements of your departure flight as well as your return through FPI Accredited Travel Agent.
HOUSING
DEPOSIT
(If Applicable)
Start paying your Housing Deposit – Review your Job Offer if the housing deposit is payable PRIOR TO YOUR ARRIVAL IN THE US
AIRFARE
DEPOSIT
(On or before
January 15, 2017)
Start paying your airfare deposit to FPI’s accredited travel agent/s bank account to secure your plane ticket’s booking.
Present ALL original deposit slip payments (Php 5750, $500, $1045 and airfare deposit) to claim your passport with visa.
CFO PRE-
DEPARTURE
ORIENTATION
(PDOS-CFO)
Attend the government Pre Departure Orientation Seminar
(PDOS-CFO) with the Commission on Filipino Overseas (CFO) as soon as you claim your passport at FPI Office.
Accomplished CFO Registration Form
Passport – original and photocopy
J1 Visa – original and photocopy
DS2019 (Certificate of Eligibility) – original and photocopy
2x2 Photo and School ID
Php 400 Registration Fee
For first timers, register online for reservation.
(separate and detailed instructions will be given as soon as your visa is approved)
FPI PRE-
DEPARTURE
ORIENTATION
BRIEFING
(PDOB-FPI)
You will also attend the Pre Departure Orientation Briefing (PDOB-FPI) with First Place as required by the US State Department.
Date, time and venue to be announced through your FPI Gmail and FPI Student Portal
DEPARTURES Fly to the US for your Work and Travel Program
WHILE IN THE
US
Your program begins
Participant must register SEVIS
PARTICIPANT – a student who successfully started the work and travel program
Submit Monthly Program Evaluation
ARRIVALS Arrival in the Philippines after your program
Submit Post Program Requirements to be announced before going back to the Philippines
Profiling Fee: PHP 5,750
Program Fee*: $ 1, 495
SEVIS Fee: $ 35
Bank and Courier Fee $ 15
*The $500 program fee deposit is deductible from the total program fees.
*Penalties will be applied for delayed or incomplete documents submissions as stated in WAT Form 3
(Terms and Conditions)
*Keep deposit slips of all your payments and fees until completion of your program for future reference.
CHECKLIST
PAYMENTS:
Housing Deposit
(IF APPLICABLE ONLY)
Airfare Deposit
DOCUMENTS:
WAT Form 6 –Final
Travel
Arrangement and
Waiver
ORIENTATIONS:
PDOS - CFO
PDOB - FPI
GET READY for the TRIP!
PROGRAM FEES
DEADLINE:
Immediately after
your visa has been
approved
WAT Form 1 - DECLARATION OF ACCEPTANCE OF PROCEDURES 2017 USA Work and Travel Program
DECLARATION OF ACCEPTANCE OF PROCEDURE
This is to confirm that, I, together with my parents/legal guardians, have fully read and understood the contents of the program application guide as well as the procedures and all documents required in processing my US Work and Travel Program application.
I will be required to keep this guide throughout the application process and will use this as my reference before filling out or submitting any of the forms included in this Application Kit 1
We attest to the authenticity of all the documents that we will submit to FPI, the embassy, the host company and the US Program Sponsor. Any falsification of documents can lead to the cancellation of my program.
We understand that the host company and the US Program Sponsor will require additional documents in processing my application such as but not limited to doctor’s certificate, guidance counsellor’s evaluation and other medical records.
We understand that program sponsor fees may change based on new notices and invoices issued by the US Sponsor.
We are aware that ALL Program Fees in dollars must be paid in US DOLLARS ONLY and should be deposited directly to FPI Dollar Accounts.
We also understand that all deposit slips must be kept throughout the application process for proper payment reference.
We understand that SEVIS, bank charges, international courier fees, airfares, transfers, food, housing, pocket money, and visa application fees are additional costs and are not included in the program fees.
We are fully aware of the cancellation and refund policy and that cancellation and requests for refund must be in writing and subject to approval by either FPI or the US Sponsor. We understand that submission of incomplete requirements will result in processing delays. PARTICIPANT’S FULL NAME:
SIGNATURE: DATE (MM/DD/YYYY):
FATHER’S NAME/LEGAL GUARDIAN:
SIGNATURE:
MOTHER’S NAME/LEGAL GUARDIAN:
SIGNATURE:
WAT Form 2 - PROGRAM APPLICATION FORM
2017 USA Work and Travel Program
www.firstplaceinc.org
PLEASE FILL UP FORM USING CAPITAL LETTERS AND CHECK APPOPRIATE BOXES. WRITE "N/A" IF QUESTION IS NOT APPLICABLE TO YOU. PERSONAL INFORMATION
PICTURE HERE
FAMILY NAME:
FIRST NAME:
MIDDLE NAME:
GENDER: M F
STATUS: SINGLE MARRIED
DATE OF BIRTH:(MM/DD/YYYY)
AGE:
IF MARRIED, NAME OF SPOUSE: SPOUSE'S CONTACT NUMBER: CITY OF BIRTH: COUNTRY OF BIRTH: CITIZENSHIP: RELIGION: CONTACT INFORMATION
PERMANENT ADDRESS:
POSTAL CODE:
CITY & PROVINCE:
COUNTRY:
LANDLINE (WITH AREA CODE): PRIMARY MOBILE NUMBER:
SECONDARY MOBILE NUMBER:
SKYPE ID:
OFFICIAL FPI GMAIL ACCOUNT: @gmail.com
PERSONAL EMAIL:
PASSPORT DETAILS
PASSPORT NUMBER:
ISSUING COUNTRY:
CITY WHERE ISSUED:
STATE WHERE ISSUED: PROVINCE WHERE ISSUED: EXPIRATION DATE: NOTE: MUST BE VALID UNTIL JANUARY 2018 (FOR SPRING); APRIL 2018 (FOR SUMMER) FAMILY BACKGROUND
FATHER:
FATHER'S CONTACT NUMBER:
ADDRESS:
EMAIL ADDRESS:
OCCUPATION:
MOTHER:
MOTHER'S CONTACT NUMBER:
ADDRESS:
EMAIL ADDRESS:
OCCUPATION:
LEGAL GUARDIAN:
RELATIONSHIP:
GUARDIAN'S CONTACT NUMBER:
ADDRESS:
OCCUPATION:
ACADEMIC AND PROFESSIONAL BACKGROUND
ARE YOU A FULL TIME ENROLLED UNIVERSITY STUDENT IN THE PHILIPPINES? YES NO YEAR LEVEL: NAME OF UNIVERSITY/SCHOOL/COLLEGE (PLEASE INCLUDE BRANCH): CITY/PROVINCE:
FIELD OF STUDY/COURSE:
DO YOU HAVE ANY WORK EXPERIENCE? YES NO
HAVE YOU ATTENDED SEMINARS/TRAININGS RELATED TO YOUR FIELD OF STUDY/COURSE? YES NO LIST DOWN YOUR MOST RECENT JOB & COMPANY & INCLUSIVE DATES LIST DOWN YOUR MOST RECENT SEMINAR/TRAINING ATTENDED JOB TITLE AND COMPANY
DATES (MM/YY)
NAME OF SEMINAR/TRAINING AND VENUE DATES (MM/YY)
WAT Form 2 - PROGRAM APPLICATION FORM
2017 USA Work and Travel Program
www.firstplaceinc.org
PERSONAL ESSAY AND SKILLS ASSESSMENT
WHY DID YOU JOIN THE US WORK AND TRAVEL PROGRAM?
WHAT DO YOU THINK WILL BE YOUR GREATEST CHALLENGE WORKING OR LIVING OVERSEAS? DO YOU PREFER WORKING ALONE OR IN A GROUP? EXPLAIN WHY. HOBBIES:
COMPUTER SKILLS: BEGINNER INTERMEDIATE ADVANCED FOREIGN LANGUAGES YOU SPEAK (ASIDE FROM
ENGLISH):
DO YOU KNOW HOW TO SWIM? YES NO HAVE YOU UNDERGONE ANY RED CROSS CERTIFICATION? (I.E. LIFEGUARD, FIRST AID) YES NO TRAVEL AND VISA INFORMATION
HAVE YOU EVER
APPLIED FOR A US YES NO
VISA BEFORE?
TYPE OF USA VISA YOU LAST APPLIED FOR: IMMIGRANT *
NON-IMMIGRANT**
WAS YOUR VISA
APPROVED? YES NO
*IF IMMIGRANT, WHO PETITIONED
YOU?
CURRENT STATUS OF IN PROCESS CANCELLED/DENIED
PETITION: COMPLETED/APPROVED
**IF NON-IMMIGRANT, WHAT VISA
CLASS? (i.e. Tourist, student, working, etc)
IS IT STILL VALID? YES NO
EXPIRY YES
DATE
(MM/DD/YYYY) NO
HAVE YOU EVER BEEN
REFUSED ENTRY INTO YES NO
ANY COUNTRY?
DECLARATION OF RELATIVES IN THE US
DO YOU HAVE PARENT/S, BROTHER/S OR SISTER/S, CHILDREN, SPOUSE IN THE US?
YES NO
DO YOU HAVE AUNT/S, UNCLE/S, GRANDPARENT/S,
COUSIN/S, IN-LAW/S AND OTHER RELATIVES IN THE YES NO US?
*IF YOU DECLARED THAT YOU HAVE IMMEDIATE FAMILY MEMBER/S, RELATIVE/S IN THE US, PLEASE FILL OUT BELOW: FULL NAME/S
RELATIONSHIP
LOCATION
STATUS
(CITIZEN, IMMIGRANT, NON- IMMIGRANT, UNDOCUMENTED) PARTICIPANT DECLARATION
I HEREBY CONFIRM THAT THE INFORMATION WRITTEN IN THIS FORM ARE ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT ANY FALSIFICATION OF DETAILS WRITTEN IN THIS FORM CAN LEAD TO THE CANCELLATION OF MY APPLICATION TO THE US WORK AND TRAVEL PROGRAM PARTICIPANT FULL NAME:
PARTICIPANT SIGNATURE: DATE (MM/DD/YYYY):
www.firstplaceinc.org
SAMPLE RESUME
2017 USA WORK & TRAVEL PROGRAM
THIS IS ONLY A
SAMPLE
Submit a typewritten resume following this format and give as many information as possible. Please attach your photo (NOTE: Follow prescribed photo guidelines) JUAN PAOLO D. DELA CRUZ
No. 123 Magsaysay Avenue, Diliman
Quezon City 1101
Telephone No. (02) 999-92-72
Mobile No. 091*-***-**-**
Birth Date: February 30, 1992
Birth City: Metro Manila
Email: ac1pjp@r.postjobfree.com
Skype: juan.delacruz
OBJECTIVE: I want to participate in the Work and Travel program because I want to travel and experience life in the US. I also would like to meet students from other countries. EDUCATION: Bachelor of Science in Hotel and Restaurant Management June 2007 – Present
XYZ University, Quezon City
Philippines
Major subjects taken:
Food Preparation
Marketing in HRM
HRD and Management in the Hotel Industry
Hotel and Restaurant Cost Control and Analysis
Bar Management
Quantity Food Production
Catering Management, Food Merchandising and Cooking Front Office and Housekeeping Management
***IMPORTANT NOTE: INCLUDE OTHER SCHOOL/S ATTENDED AND COURSE/S TAKEN PRIOR TO YOUR CURRENT EDUCATION (if there is any)
WORK EXPERIENCE / OJT / RELATED SCHOOL ACTIVITIES:
(NOTE: if you do not have work experience, mention any school activities related to your course, seminars attended) Trainee / OJT
November 15, 2009 – January 15, 2010
Shangri-la Hotel
Makati City, Philippines
DUTIES AND RESPONSIBILITIES:
• Trained in kitchen operations and learned the different methods of food preparation
• Trained in the Pastry Department and learned the methods of cake decorating HOBBIES: Singing, playing badminton, swimming
OTHER SKILLS: Cooking, baking, driving
COMPUTER SKILLS: MS Word, Excel, Powerpoint, etc.
LANGUAGES: English, Spanish, French, Chinese
INSERT 2x2 SMILING
PHOTO HERE
www.firstplaceinc.org
WAT Form 4 - HEALTH QUESTIONNAIRE
2017 USA Work and Travel Program
*Must be completed by a registered physician
*Please attach the following: Chest Xray Result Personality Test Result conducted by First Place / School Counselor / Accredited Provider
Have you been hospitalized for a serious injury or operation? YES NO If yes, explain Are you physically impaired or is your movement restricted? YES NO If yes, explain Do you have any mental/emotional health issues? YES NO If yes, explain Do you have any dietary restrictions? YES NO If yes, explain Do you have any allergies? YES NO If yes, explain Are you currently on any medication? YES NO If yes, explain Have you ever had the following immunizations?
POLIOMYELITIS
If Yes, please indicate date of immunization:
MEASLES, MUMPS & RUBELLA (MMR)
If Yes, please indicate date of immunization:
MENINGITIS VACCINATION
If Yes, please indicate date of immunization:
HEPATITIS A & B VACCINATION
If Yes, please indicate date of immunization:
Have you ever had any disease or illness involving the following?
Blood or Endocrine System
Bones
Brain or Nervous System
Ears or Hearing
Eyes or Sight
Genito-urinary System
Heart
Joints or Locomotive
Lungs or Respiratory System
Nose or Throat
Other Abdominal Organs
Stomach or Digestive System
Tonsils
If yes, please specify: Please state the patient overall health: I certify to the best of my knowledge that the information shown above is correct: NAME (Please Print): DATE: GENDER: BIRTHDATE (Month/Day/Year): Have you ever had or ever suffered from any of the following conditions?
Anorexia
Allergies
Anxiety Attacks
Appendicitis
Asthma
Bulimia
Chicken Pox
Cold Sores
Depression
Diabetes
Epilepsy
Hernia
HIV/AIDS
Hepatitis (A,B or C)
Doctor’s Name: Signature: Date: License Number: Applicant’s Signature: Parent/Guardian’s Signature: EMERGENCY CARE:
I authorize US Visa Sponsor to make decisions on my behalf on appropriate emergency care, and have access to all my medical and health records. I also authorize licensed physicians and hospitals to provide treatment as needed. Measles
Meningitis
Mumps
Mental or Nervous Disorder
Pneumonia
Rubella
Scarlett Fever
Serious or Persistent Cough
Serious or Persistent Headaches
Tuberculosis
Typhoid Fever
Ulcer
Vertigo/Dizziness
2017 USA Work and Travel
www.firstplaceinc.org
WAT Form 5 - RETURN GUARANTEE AGREEMENT
US WORK AND TRAVEL RETURN GUARANTEE
AGREEMENT WITH PROVISION FOR LIQUIDATED
DAMAGES
1. BASIC UNDERTAKINGS
We,
(Name of Parents / Guardians and Guarantors)
hereby acknowledge that through the efforts of First Place, Inc. (FPI),
(Participant Name)
shall be attending and participating in the US Work and Travel Program
(the “Program”), for the period
2017 to 2017. In connection with the obligations/undertakings under the US Work and Travel Program Terms and Conditions we signed earlier and in our capacity as the parents/guardian(s) / relative(s) / guarantors of the Participant, we hereby agree to jointly and solidarily oblige ourselves together with the Participant to ensure and guarantee that: A. The Participant shall immediately return to the Philippines within thirty (30) days after the Program completion date as indicated in the Participant’s Form DS-2019, or within five (5) days if the Program is terminated by the US sponsor or the Participant is expelled or quits from the Program. Such return shall be demonstrated by the participant’s physical appearance at the office of First Place, Inc. in Bahay ng Alumni, UP Diliman, Q.C. within seventy-two (72) hours from his/her arrival date, and presentation to any responsible officer of First Place, Inc. of his/her original passport with a valid re-entry stamp to the Philippines, completed three
(3) monthly and final evaluation forms, detailed financial report of income and expenses with copy of all pay slips. B. The Participant shall not seek any change of visa status while in the US even if allowed by US laws. Therefore, any change in visa status must be made only after
returning to the Philippines; and
C. The Participant shall fully comply with the Terms and Conditions of the Program.
We acknowledge that the participant’s violation of such obligations will adversely affect the Program, the US Sponsor, First Place, Inc., and the School as well as participants family members.
2. PENALTY FOR FAILURE TO COMPLY
In the event of any failure to promptly and fully comply with the foregoing basic undertakings, we agree and undertake to jointly and solidarily pay to First Place, Inc. without need of demand at its principal place of business, the amount of PHILIPPINE PESOS: TWO MILLION
(PHP2, 000,000.00), within seven (7) days from the lapse of the deadline for the Participant’s return to the Philippines. Failure to physically appear in our office within seventy two (72) hours shall incur an additional penalty of PHILIPPINE PESOS TEN THOUSAND
(P 10,000.00).
Additionally, if the Participant has unpaid accounts with First Place, Inc., the US Program Sponsor, or the Accredited Travel Agency, we further agree to pay these accounts.
3. INVOLVED PARTY TO THE AGREEMENT
We hereby agree and understand that the US Host Company, the US Sponsor, the US Embassy in Manila and the Schools are not parties to this agreement.
4. GENERAL PROVISIONS
This Agreement is the complete and exclusive statement of the agreement between First Place, Inc. and us. This supersedes all understandings or prior agreements, whether oral or written, and all representations or other communications.
The parties shall submit proof of financial viability such as, but not limited to, employment certificate, proof of business ownership, ITR, bank statements, copies of TCT of real estate properties. They shall execute such other additional documents as may be reasonably necessary to carry out the intent of this Agreement. If any provision of this Agreement is found by any court or administrative body of competent jurisdiction to be invalid or unenforceable, the invalidity or unenforceability of such provision shall not affect the other provisions of this Agreement, and all provisions not affected by such invalidity or unenforceability shall remain in full force and effect. The parties agree to substitute any invalid or unenforceable provision with a valid or enforceable provision which achieves to the greatest extent possible the objectives of the invalid or unenforceable provision.
5. PERSONAL CIRCUMSTANCES AND CONTACT DETAILS
Name of Parents / Legal Guardians
Guardian’s Relationship to Applicant
Residence
Provincial Address
Office Address
Home Phone/Office Phone/Mobile Phone
Email Address
2017 USA Work and Travel
www.firstplaceinc.org
WAT Form 5 - RETURN GUARANTEE AGREEMENT
Name of First Guarantor and Relationship to Participant Residence Provincial Address Home Phone Office Phone Mobile Phone Email Name of Second Guarantor and Relationship to Participant Residence Provincial Address Home Phone Office Phone Mobile Phone Email IN WITNESS WHEREOF, we have hereunto attached our signatures this day of, at .
Signature over Printed Name of PARTICIPANT
Signature over Printed Name OF PARENT
Signature over Printed Name OF GUARDIAN
Signature over Printed Name of FIRST GUARANTOR
Signature over Printed Name OF PARENT
Signature over Printed Name OF GUARDIAN
Signature over Printed Name of SECOND GUARANTOR
Conforme:
FIRST PLACE, INC.
Witnessed by:
ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES)
) S.S.
Before me, a notary public for and in, Philippines, on this day of, personally appeared the following:
NAME
ID NUMBER
ISSUED ON/AT
All known to me to be the same persons who executed the foregoing instrument, and who acknowledged to me that the same is their free and voluntary act and deed, and that of the corporation represented. The foregoing instrument pertains to a Return Guarantee Agreement with Provision for Liquidated Damages consisting of two (2) pages including this page, duly signed by the parties and their instrumental witnesses. IN WITNESS WHEREOF, I have hereunder set my hand and affixed my notarial seal on the date and at the place above written. Doc. No. ;
Page No. ;
Book No. ;
Series of .
www.firstplaceinc.org
WAT Form 6 - TRAVEL ARRANGEMENT and WAIVER
2017 USA Work and Travel Program
I FULLY UNDERSTAND AND AGREE THAT:
It is MANDATORY that I get from FPI’s accredited travel agencies ONLY my ROUNDTRIP airline ticket from the Philippines to the US airport as suggested by my host company or specified in my Job Offer/Job Description and back to Philippines.
I shall deposit to FPI’s dollar account, my initial airfare payment of $1,000 deductible from my final airfare amount seven (7) days before my US Embassy interview or not later than January 15, 2017 with or
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