On-Campus Employment Eligibility Verification

I hereby certify that _____________________________________ is

a. _____ an international student at Lewis and Clark College who entered the U.S. on a(n):

_____ F-1 visa

_____ J-1 visa (Student Category ONLY)**

_____ Other: (Please specify) __________________________

**Please note that international scholars on J-1 visas in categories other than "Student," may not work on or off campus unless the work is directly related to their field of study and included in their approved program.

Or

b._____ the spouse/dependent of an international student at Lewis and Clark College (Student's name: _____________________________). The spouse entered the U.S. on a

_____ J-2 visa

_____ Other: (Please specify) _________________________

and that the spouse/dependent has proven to my satisfaction that he/she has been granted permission to work by INS (I-94 INS validation required). According to Department of Homeland Security regulations, a J-2 visa holder may engage in "any type of employment without limitation as to full time or part time" but with the understanding that income will be used on only for himself/herself and not for the J-1 visa holder. (Social Security taxes shall be withheld). Social Security Number required: ____________________.

And

c. _____ that the student named above is currently enrolled and on the colleague computer system, qualifying him/her for payment through the student payroll system.

If you have any questions or concerns, please call International Students and Scholars at x7305.

This Form Is Valid Only Until: _____________________ (End of current academic year)

Current Date______________

L&C Seal/STAMP

International Students and Scholars Use Only

Note to ISS staff: Send copy of this form to the Payroll Office, and place a copy in the student's file.