INTERNATIONALSTUDENTSERVICES•UNIVERSITYOFHAWAI‘IATMĀNOA2600CampusRoad,QLCSS206,Honolulu,HI96822•Phone:(808)956‐8613•Fax:(808)956‐5076
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J-CE
J-1On-CampusEmploymentEligibilityandAuthorizationForm
Whenproperlycompleted,thisformprovides(1)theperiodinwhichaJ-1studentiseligibleforemployment;and(2)authorizationsforspecificemployment.Eligibilitydoesnotconstituteauthorization.
SECTIONI.StudentAcknowledgment.TobecompletedbyJ-1student.StudentSurname/FamilyName / StudentGivenName(s) / UHID#
DS-2019ExpirationDate(mm/dd/yyyy) / PassportExpirationDate(mm/dd/yyyy)
TotheStudent:Pleasefillinyourinformationabove,readtheon-campusemploymentstipulationsbelowandsigninthespaceprovided,thensubmittothisformtoanISSadvisor.
□IftheRO/AROchoosestolimitthenumberofhoursperweekthestudentmaywork,(s)heshouldinformthestudent.Otherwise,thestudentwillbeadvisedbytheROthatworkwillnotexceed20hoursperweekduringtheacademicperiodpursuanttotheUHAPMA9.880.
□TheMānoaCareerCenter(MCC)willconsideranyvalidStudentEmploymentWorkAgreement(SEWA)uponreceiptofthisform.Approvalwillbegiveninaccordancetocurrent,standardMCCprocedure.
□ThisverificationdoesnotincludeeligibilityrequirementsenforcedbyMCC.StudentsdeemedineligiblebyMCCwillbeprecludedfromaccessingtheStudentEmploymentandCooperativeEducation(SECE)on-linejobsystemand/orestablishmentofstudentemploymentpayrollrecords.
□Ifthestudentisnotcurrentlyengagedinfull-timecoursework,thisformmustbeaccompaniedbywrittenverificationissuedbytheRO/AROattestingthatstudentisauthorizedforareducedcourseload(RCL).
□On-campusemploymentmayincludejobsatotherUHcampusesonOahu,duetosystem-wideagreements.
□Anyon-campusemploymentsuccessfullyobtainedbythestudentthroughMCCduringtheeligibilityperiodmustbeauthorizedbyanRO/ARObeforeemploymentmaybegin.EachjobmustberecordedonthebacksideofthisformbythestudentandsubmittedtoanISSadvisorforauthorization.
□TheRO/AROmayusetheDS-2019enddate,passportexpirationdate,orcompletionofprogram,whicheverisearlier,todetermineeligibilityandauthorizationdates.
□AnychangestoemploymentdatesmustbereportedimmediatelytotheISSadvisor.
StudentCertification:Astheabove-namedstudent,IherebycertifythatIhaveread,understand,andwillabidebythestipulationslistedinSectionI.
StudentSignature / Date(mm/dd/yyyy)
SECTIONII.EmploymentEligibility.TobecompletedbyISSAdvisorwhoisaResponsibleOfficer(RO)orAlternateResponsibleOfficer(ARO)oranRO/AROofthestudent’ssponsoringagency.
RO/AROCertification:AsResponsibleOfficer/AlternateResponsibleOfficer,Iherebycertifythattheabove-namedstudentiseligibleforon-campusemploymentforthefollowingperiod:
StudentOn-CampusWorkEligibilityPeriod
StartDate(mm/dd/yyyy):EndDate(mm/dd/yyyy):
RO/AROName / RO/AROSignature / Date(mm/dd/yyyy)
SEEBACKSIDE
SectionIIIonthesecondpagemustbecompletedandsubmittedbythestudenttoISSforauthorizationassoonasemploymentissuccessfullyobtained.Eachjobmustbeauthorized,andemploymentmaynotbeginuntilauthorized.
Updated:September8,2017
(formJ-CEcontinued)
SECTIONIII.EmploymentInformation.Employmentinformationmustbecompletedbythestudentforeachjobobtainedduringtheeligibilityperiod.ThesectionforauthorizationshallbecompletedbyanRO/ARO.PositionTitle / SupervisorName / EmployerName
DatesofEmployment(mm/dd/yyyy–mm/dd/yyyy)
StartDate:EndDate: / SupervisorPhone / Hours/Week / StreetAddress / State / ZipCode
Authorized?
□Yes□No / SEVISEntryDate / RO/AROName / RO/AROSignature / Date(mm/dd/yyyy)
PositionTitle / SupervisorName / EmployerName
DatesofEmployment(mm/dd/yyyy–mm/dd/yyyy)
StartDate:EndDate: / SupervisorPhone / Hours/Week / StreetAddress / State / ZipCode
Authorized?
□Yes□No / SEVISEntryDate / RO/AROName / RO/AROSignature / Date(mm/dd/yyyy)
PositionTitle / SupervisorName / EmployerName
DatesofEmployment(mm/dd/yyyy–mm/dd/yyyy)
StartDate:EndDate: / SupervisorPhone / Hours/Week / StreetAddress / State / ZipCode
Authorized?
□Yes□No / SEVISEntryDate / RO/AROName / RO/AROSignature / Date(mm/dd/yyyy)
PositionTitle / SupervisorName / EmployerName
DatesofEmployment(mm/dd/yyyy–mm/dd/yyyy)
StartDate:EndDate: / SupervisorPhone / Hours/Week / StreetAddress / State / ZipCode
Authorized?
□Yes□No / SEVISEntryDate / RO/AROName / RO/AROSignature / Date(mm/dd/yyyy)
PositionTitle / SupervisorName / EmployerName
DatesofEmployment(mm/dd/yyyy–mm/dd/yyyy)
StartDate:EndDate: / SupervisorPhone / Hours/Week / StreetAddress / State / ZipCode
Authorized?
□Yes□No / SEVISEntryDate / RO/AROName / RO/AROSignature / Date(mm/dd/yyyy)