USCIS Form I-765 "Application for Employment Authorization"

USCIS Form I-765 is a U.S. Department of Homeland Security - Citizenship and Immigration Services form also known as the "Application For Employment Authorization". The latest edition of the form was released in May 31, 2018 and is available for digital filing.

Download a PDF version of the USCIS Form I-765 down below or find it on U.S. Department of Homeland Security - Citizenship and Immigration Services Forms website.

Step-by-step Form 765 instructions can be downloaded by clicking this link.

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Download USCIS Form I-765 "Application for Employment Authorization"

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USCIS
Application For Employment Authorization
Form I-765
Department of Homeland Security
OMB No. 1615-0040
U.S. Citizenship and Immigration Services
Expires 05/31/2020
Authorization/Extension
Fee Stamp
Action Block
Valid From
Authorization/Extension
For
Valid Through
USCIS
Use
Only
A-
Alien Registration Number
Remarks
Select this box if Form G-28
Attorney or Accredited Representative
To be completed by an attorney or
is attached.
USCIS Online Account Number (if any)
Board of Immigration Appeals (BIA)-
accredited representative (if any).
START HERE - Type or print in black ink.
Other Names Used
Part 1. Reason for Applying
Provide all other names you have ever used, including aliases,
I am applying for (select only one box):
maiden name, and nicknames. If you need extra space to
1.a.
Initial permission to accept employment.
complete this section, use the space provided in Part 6.
1.b.
Replacement of lost, stolen, or damaged employment
Additional Information.
authorization document, or correction of my
2.a. Family Name
employment authorization document NOT DUE to
(Last Name)
U.S. Citizenship and Immigration Services (USCIS)
2.b. Given Name
error.
(First Name)
NOTE: Replacement (correction) of an employment
2.c. Middle Name
authorization document due to USCIS error does not
require a new Form I-765 and filing fee. Refer to
3.a.
Family Name
Replacement for Card Error in the What is the
(Last Name)
Filing Fee section of the Form I-765 Instructions for
3.b. Given Name
further details.
(First Name)
1.c.
Renewal of my permission to accept employment.
3.c. Middle Name
(Attach a copy of your previous employment
authorization document.)
4.a.
Family Name
(Last Name)
4.b.
Given Name
Part 2. Information About You
(First Name)
4.c.
Middle Name
Your Full Legal Name
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name
Form I-765 05/31/18
Page 1 of 7
USCIS
Application For Employment Authorization
Form I-765
Department of Homeland Security
OMB No. 1615-0040
U.S. Citizenship and Immigration Services
Expires 05/31/2020
Authorization/Extension
Fee Stamp
Action Block
Valid From
Authorization/Extension
For
Valid Through
USCIS
Use
Only
A-
Alien Registration Number
Remarks
Select this box if Form G-28
Attorney or Accredited Representative
To be completed by an attorney or
is attached.
USCIS Online Account Number (if any)
Board of Immigration Appeals (BIA)-
accredited representative (if any).
START HERE - Type or print in black ink.
Other Names Used
Part 1. Reason for Applying
Provide all other names you have ever used, including aliases,
I am applying for (select only one box):
maiden name, and nicknames. If you need extra space to
1.a.
Initial permission to accept employment.
complete this section, use the space provided in Part 6.
1.b.
Replacement of lost, stolen, or damaged employment
Additional Information.
authorization document, or correction of my
2.a. Family Name
employment authorization document NOT DUE to
(Last Name)
U.S. Citizenship and Immigration Services (USCIS)
2.b. Given Name
error.
(First Name)
NOTE: Replacement (correction) of an employment
2.c. Middle Name
authorization document due to USCIS error does not
require a new Form I-765 and filing fee. Refer to
3.a.
Family Name
Replacement for Card Error in the What is the
(Last Name)
Filing Fee section of the Form I-765 Instructions for
3.b. Given Name
further details.
(First Name)
1.c.
Renewal of my permission to accept employment.
3.c. Middle Name
(Attach a copy of your previous employment
authorization document.)
4.a.
Family Name
(Last Name)
4.b.
Given Name
Part 2. Information About You
(First Name)
4.c.
Middle Name
Your Full Legal Name
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name
Form I-765 05/31/18
Page 1 of 7
13.b.
Provide your Social Security number (SSN) (if known).
Part 2. Information About You (continued)
Your U.S. Mailing Address
Do you want the SSA to issue you a Social Security card?
14.
(You must also answer “Yes” to Item Number 15.,
5.a.
In Care Of Name (if any)
Consent for Disclosure, to receive a card.)
Yes
No
Street Number
5.b.
NOTE: If you answered “No” to Item Number 14., skip
and Name
to Part 2., Item Number 18.a. If you answered “Yes” to
5.c.
Apt.
Ste.
Flr.
Item Number 14., you must also answer “Yes” to Item
Number 15.
5.d. City or Town
Consent for Disclosure: I authorize disclosure of
15.
information from this application to the SSA as required
5.e. State
5.f.
ZIP Code
for the purpose of assigning me an SSN and issuing me a
(USPS ZIP Code Lookup)
Social Security card.
Yes
No
6.
Is your current mailing address the same as your physical
address?
NOTE: If you answered “Yes” to Item Numbers
Yes
No
14. - 15., provide the information requested in Item
Numbers 16.a. - 17.b.
NOTE: If you answered “No” to Item Number 6.,
provide your physical address below.
Father's Name
Provide your father's birth name.
U.S. Physical Address
16.a. Family Name
7.a. Street Number
(Last Name)
and Name
16.b. Given Name
7.b.
Apt.
Ste.
Flr.
(First Name)
Mother's Name
7.c. City or Town
Provide your mother's birth name.
7.d. State
7.e. ZIP Code
17.a. Family Name
(Last Name)
Other Information
17.b. Given Name
(First Name)
8.
Alien Registration Number (A-Number) (if any)
A-
Your Country or Countries of Citizenship or
Nationality
9.
USCIS Online Account Number (if any)
List all countries where you are currently a citizen or national.
If you need extra space to complete this item, use the space
10.
Gender
Male
Female
provided in Part 6. Additional Information.
18.a.
Country
11.
Marital Status
Single
Married
Divorced
Widowed
18.b.
Country
12.
Have you previously filed Form I-765?
No
Yes
13.a.
Has the Social Security Administration (SSA) ever
officially issued a Social Security card to you?
Yes
No
NOTE: If you answered “No” to Item Number 13.a.,
skip to Item Number 14. If you answered “Yes” to Item
Number 13.a., provide the information requested in Item
Number 13.b.
Form I-765 05/31/18
Page 2 of 7
Part 2. Information About You (continued)
Information About Your Eligibility Category
27.
Eligibility Category. Refer to the Who May File Form
Place of Birth
I-765 section of the Form I-765 Instructions to determine
the appropriate eligibility category for this application.
List the city/town/village, state/province, and country where
Enter the appropriate letter and number for your eligibility
you were born.
category below (for example, (a)(8), (c)(17)(iii)).
19.a. City/Town/Village of Birth
(
)
(
)
(
)
28.
(c)(3)(C) STEM OPT Eligibility Category. If you
19.b.
State/Province of Birth
entered the eligibility category (c)(3)(C) in Item Number
27., provide the information requested in Item Numbers
28.a - 28.c.
19.c.
Country of Birth
28.a.
Degree
28.b.
Employer's Name as Listed in E-Verify
20.
Date of Birth (mm/dd/yyyy)
28.c.
Employer's E-Verify Company Identification Number or a
Information About Your Last Arrival in the
Valid E-Verify Client Company Identification Number
United States
21.a.
Form I-94 Arrival-Departure Record Number (if any)
29.
(c)(26) Eligibility Category. If you entered the eligibility
category (c)(26) in Item Number 27., provide the receipt
number of your H-1B spouse's most recent Form I-797
21.b.
Passport Number of Your Most Recently Issued Passport
Notice for Form I-129, Petition for a Nonimmigrant
Worker.
21.c.
Travel Document Number (if any)
30.
(c)(8) Eligibility Category. If you entered the eligibility
category (c)(8) in Item Number 27., have you EVER
21.d. Country That Issued Your Passport or Travel Document
been arrested for and/or convicted of any crime?
Yes
No
21.e. Expiration Date for Passport or Travel Document
NOTE: If you answered “Yes” to Item Number 30.,
(mm/dd/yyyy)
refer to Special Filing Instructions for Those With
Pending Asylum Applications (c)(8) in the Required
22.
Date of Your Last Arrival Into the United States, On or
Documentation section of the Form I-765 Instructions
About (mm/dd/yyyy)
for information about providing court dispositions.
23.
Place of Your Last Arrival Into the United States
31.a.
(c)(35) and (c)(36) Eligibility Category. If you entered
the eligibility category (c)(35) in Item Number 27., please
provide the receipt number of your Form I-797 Notice for
Immigration Status at Your Last Arrival (for example,
24.
Form I-140, Immigrant Petition for Alien Worker. If you
B-2 visitor, F-1 student, or no status)
entered the eligibility category (c)(36) in Item Number
27., please provide the receipt number of your spouse's or
parent's Form I-797 Notice for Form I-140.
25.
Your Current Immigration Status or Category (for example,
B-2 visitor, F-1 student, parolee, deferred action, or no
status or category)
31.b.
If you entered the eligibility category (c)(35) or (c)(36) in
Item Number 27., have you EVER been arrested for
and/or convicted of any crime?
Yes
No
26.
Student and Exchange Visitor Information System
(SEVIS) Number (if any)
NOTE: If you answered “Yes” to Item Number 31.b.,
refer to Employment-Based Nonimmigrant Categories,
N-
Items 8. - 9., in the Who May File Form I-765 section
of the Form I-765 Instructions for information about
providing court dispositions.
Form I-765 05/31/18
Page 3 of 7
Applicant's Declaration and Certification
Part 3. Applicant's Statement, Contact
Information, Declaration, Certification, and
Copies of any documents I have submitted are exact photocopies
Signature
of unaltered, original documents, and I understand that USCIS
may require that I submit original documents to USCIS at a later
NOTE: Read the Penalties section of the Form I-765
date. Furthermore, I authorize the release of any information
Instructions before completing this section. You must file
from any and all of my records that USCIS may need to
Form I-765 while in the United States.
determine my eligibility for the immigration benefit that I seek.
I furthermore authorize release of information contained in this
Applicant's Statement
application, in supporting documents, and in my USCIS
NOTE: Select the box for either Item Number 1.a. or 1.b. If
records, to other entities and persons where necessary for the
applicable, select the box for Item Number 2.
administration and enforcement of U.S. immigration law.
I can read and understand English, and I have read
I understand that USCIS may require me to appear for an
1.a.
and understand every question and instruction on this
appointment to take my biometrics (fingerprints, photograph,
application and my answer to every question.
and/or signature) and, at that time, if I am required to provide
biometrics, I will be required to sign an oath reaffirming that:
The interpreter named in Part 4. read to me every
1.b.
question and instruction on this application and my
1) I reviewed and understood all of the information
answer to every question in
contained in, and submitted with, my application; and
,
2) All of this information was complete, true, and correct
a language in which I am fluent, and I understood
at the time of filing.
everything.
I certify, under penalty of perjury, that all of the information in
2.
At my request, the preparer named in Part 5.,
my application and any document submitted with it were
provided or authorized by me, that I reviewed and understand
,
all of the information contained in, and submitted with, my
prepared this application for me based only upon
application and that all of this information is complete, true, and
information I provided or authorized.
correct.
Applicant's Contact Information
Applicant's Signature
3.
Applicant's Daytime Telephone Number
7.a.
Applicant's Signature
4.
Applicant's Mobile Telephone Number (if any)
7.b.
Date of Signature (mm/dd/yyyy)
NOTE TO ALL APPLICANTS: If you do not completely fill
5.
Applicant's Email Address (if any)
out this application or fail to submit required documents listed
in the Instructions, USCIS may deny your application.
6.
Select this box if you are a Salvadoran or Guatemalan
national eligible for benefits under the ABC
Part 4. Interpreter's Contact Information,
settlement agreement.
Certification, and Signature
Provide the following information about the interpreter.
Interpreter's Full Name
1.a.
Interpreter's Family Name (Last Name)
1.b.
Interpreter's Given Name (First Name)
2.
Interpreter's Business or Organization Name (if any)
Form I-765 05/31/18
Page 4 of 7
Part 5. Contact Information, Declaration, and
Part 4. Interpreter's Contact Information,
Signature of the Person Preparing this
Certification, and Signature
Application, If Other Than the Applicant
Interpreter's Mailing Address
Provide the following information about the preparer.
3.a.
Street Number
Preparer's Full Name
and Name
3.b.
Apt.
Ste.
Flr.
1.a. Preparer's Family Name (Last Name)
3.c. City or Town
1.b.
Preparer's Given Name (First Name)
3.d. State
3.e. ZIP Code
3.f.
Province
2.
Preparer's Business or Organization Name (if any)
3.g.
Postal Code
3.h. Country
Preparer's Mailing Address
3.a.
Street Number
and Name
Interpreter's Contact Information
3.b.
Apt.
Ste.
Flr.
4.
Interpreter's Daytime Telephone Number
3.c. City or Town
3.d. State
3.e. ZIP Code
5.
Interpreter's Mobile Telephone Number (if any)
3.f.
Province
6.
Interpreter's Email Address (if any)
3.g.
Postal Code
3.h. Country
Interpreter's Certification
I certify, under penalty of perjury, that:
Preparer's Contact Information
I am fluent in English and
,
which is the same language specified in Part 3., Item Number
4.
Preparer's Daytime Telephone Number
1.b., and I have read to this applicant in the identified language
every question and instruction on this application and his or her
answer to every question. The applicant informed me that he or
5.
Preparer's Mobile Telephone Number (if any)
she understands every instruction, question, and answer on the
application, including the Applicant's Declaration and
Certification, and has verified the accuracy of every answer.
6.
Preparer's Email Address (if any)
Interpreter's Signature
Interpreter's Signature
7.a.
7.b.
Date of Signature (mm/dd/yyyy)
Form I-765 05/31/18
Page 5 of 7
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