Non-Dairy Employee Request

APS Representative's Name

Business Name (required)

Physical Address (required)

Mailing Address (if different)

Business Federal ID# (required)

Business Entity Type (required)

Business Contact Person (required)

Phone # (required)

Fax Number

Cell Phone # (required)

E-mail Address (required)

Worker's Compensation Insurance Carrier Name (required)

WC Policy # (required)

WC Expiration Date: MM

YYYY

WC Contact Person (required)

WC Contact Phone # (required)

Banking Institution Name (required)

Banking Contact Person (required)

Banking Contact Phone # (required)

Names of Authorized Signers (required)

I understand that automatic or electronic payment of monthly fees will be required. (required)

# of Entry-Level Employees Needed (required)

Preferred Date of Need: MM

YYYY

Can Offer Competitive Work Hours (required)

How Many Hours of Work per Week (required)

Competitive Hourly Wage (required)

Work Shift for New Employee(s) (required)

Job Duration (required)

Please briefly describe your business and the tasks to be performed (attach additional sheets as necessary)

Equipment Operation Skills Needed (attach additional sheets as necessary)

Distance from Worksite (required)

Heat, Electricity, Clean Water (required)

Smoke Detectors in All Bedrooms (required)

Carbon Monoxide Detector (1 Central) (required)

First Aid Kit (required)

2:A Fire Extinguisher (required)

Telephone for 911 Emergency (required)

Stove & Refrigerator (required)

Dishes, Glasses, Cooking Utensils (required)

Vacuum Cleaner, Broom, Cleaning Tools (required)

Kitchen Table & Chairs (required)

Dressers, Beds w/Linens & Blankets, Bath Towels (required)

Living Room Couch or Chair (required)

High Speed Internet (required)

Reference 1 name (required)

Relationship

Phone # (required)

Reference 2 name (required)

Relationship

Phone # (required)

Reference 3 name (required)

Relationship

Phone # (required)

Please provide other information that could help us identify and train prospective employee(s):

I hereby consent to the processing of the data that I have provided to respond to my request.

Downloads

Other Request

Complete Company Name (required)

Taxpayer FEIN (required)

Doing Business As/Trade Name (if different from above)

Type of entity (required)

Where and when incorporated or established (state and year) (required)

Number of company employees (required)

Gross revenue of past year (required)

Worker's Compensation Insurance Carrier Name (required)

WC Policy # (required)

WC Expiration Date (required)

WC Contact Person (required)

WC Contact Phone # (required)

Name of Company Owner or President (required)

Website Address (required)

E-mail Address (required)

Mailing Address (required)

Street Address (required)

Main Office Phone # (required)

Person responsible for the TN Visa application process (required)

Title (required)

Main Phone # (required)

Cell Phone # (required)

E-mail Address (required)

Have you previously participated in the TN visa program? (required)

If you anticipate hiring TN visa holder(s) for more than one job category, occupation or profession, please duplicate pages 3 and 4, being sure to provide separate information for each job category, occupation or profession. If you need more space, clearly label and attach a separate sheet of paper. Please provide a brief summary of your business operations including the numbers of employees, animals, and locations. (required)

Please indicate job title or name you want to call the job for which you anticipate hiring TN visa holder(s). (required)

Please describe this job. (required)

How many TN visa holder(s) do you plan on hiring for this job? (required)

What date would you like the TN visa holder(s) to start working? (required)

Do you want the TN visa holder(s) to be available for continuous employment or would a specific employment period be preferable? (required)

What is the address where TN Visa holder(s) will work? (required)

What work schedule should your TN visa holder(s) expect during the time of employment? Mon-Fri Start and Finish time (required)

Anticipated total hours per week (required)

Is Saturday work required? (required)

How often do you pay your TN visa holder(s)? (required)

If you pay weekly or bi-weekly, which day of the week is payday? (required)

What is the minimum starting amount you would expect to offer TN visa holder(s) with a bachelor’s degree in an appropriate discipline for the job duties described above? Please specify the amount and whether it is per hour, per week, or per month. (required)

Do you intend to offer or assist TN visa holder(s) in securing housing or other boarding facilities upon arrival? (required)

If yes, please describe the housing (e.g., furnished apartments, rental home, mobile home, etc.). If housing has not yet been determined, please indicate “TBD.” (required)

If known, please provide estimated housing costs per TN visa holder(s) per week (required)

Rent per TN visa holder(s) per week (required)

Basic utilities for which TN visa holder(s) will be responsible and which are not included in rent (required)

Total rent and utilities per TN visa holder(s) per week (required)

Letter proving legitimacy of your business (such as a financial statement or Certificate of Existence from the Department of the Secretary of State from the state where your business is registered)

Download file: TN Visa Agency and Indemnity Agreement. Sign and upload

Veterinarian or Breeder name (required)

Relationship

Phone # (required)

Reference 2 name (required)

Relationship

Phone # (required)

Reference 3 name (required)

Relationship

Phone # (required)

Please provide other information that could help us identify and train prospective employee(s)

I hereby consent to the processing of the data that I have provided to respond to my request.