OPT Employment Form

This form is to be used by U-M students who are currently on Post Completion OPT and are reporting new employment. If you are on the 24 Month STEM Extension, please report your employment here: STEM Change Employer

Tags:

F-1 Students

Personal Information

Last Name: *

First Name: *

UMID: *

SEVIS ID: *

Current Email: *

Employment History

First Job or Not *

This is my first job on Post Completion OPT.

I had a previous job while on Post Completion OPT and now I have a new job.

I had a previous job while on Post Completion OPT and now I am unemployed.

I have never had a job while on Post Completion OPT.

Previous Employer Information

Previous Employer/Company Name: *

Previous Employment End Date

Month

Day

Year

*If your previous employment has not ended, you may leave the "Previous Employment End Date" field blank. Please detail any concurrent job arrangements in the comments box below.

Previous Employment

Previous Employer/Company Name: *

Previous Employment End Date *

Month

Day

Year

Current Employment Information

Employer/Company Name: *

Employment Start Date: *

Month

Day

Year

Full Time / Part Time *

Full Time: more than 20 hours/week

Part Time: 20 or less hours/week

Employment Address:

Street: *

Apt./Suite:

City: *

State: *

Zip Code: *

Comments

Certify *

I certify I have read the OPT information about Post Completion OPT available at the IC web site, and the information I have provided is, to the best of my knowledge, accurate. I understand that I (and any F-2 dependents) must have U-M approved health insurance coverage for the duration of my F-1 status. I understand I must report address changes, current (U.S.) or permanent (outside U.S.), as well as phone number and email changes, through Wolverine Access within 10 days of any change.

	1500 Student Activities Building 515 E. Jefferson Street Ann Arbor, MI 48109-1316
	734.764.9310
	icenter@umich.edu

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