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OPT Proof of Employment

OPT Proof of Employment
* The information on this document is collected for the below mentioned individual’s reporting purpose to
the U.S. Department of Homeland Securityduring his/her Optional Practical Training period.
To be completed by the Student
Name:_________________________________________________________ COC ID#:__________________
Associate Degree/Certificate Course:__________________________________________________________
To be completed by student’s Empl oye r
This is the evidenceof employment for ___________________________________________________________
Job Title: __________________________________________________________________________________
Nature of student’s job: _____________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Start Date:_________________End Date:________________ Hours/Week:more than 20 hours/week
20 or less hours/week
Employer Information:
EmployerName: ____________________________________________ Employer EIN: ________-__________
Address:_______________________________________________________________________Zip:________
Supervisor Information:
Last Name: ___________________________________ First Name:__________________________________
PhoneNumber:______________________Email Address: ________________________________________
Employer Signature:__________________________________________ Date:____________________
International Students Program 26455 Rockwell Canyons Road, Santa Clarita, CA 91355
Student’s Name
Month / Date /Year
Month / Date / Year
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