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- Form AL500HC "Field Registration Form" - New York (Haitian Creole)
Form AL500HC "Field Registration Form" - New York (Haitian Creole)
This is a legal form that was released by the New York State Department of Labor - a government authority operating within New York.
The document is provided in Haitian Creole. As of today, no separate filing guidelines for the form are provided by the issuing department.
Form Details:
- Released on October 1, 2019;
- The latest edition provided by the New York State Department of Labor;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
Download a fillable version of Form AL500HC by clicking the link below or browse more documents and templates provided by the New York State Department of Labor.
Download Form AL500HC "Field Registration Form" - New York (Haitian Creole)
![Form AL500HC "Field Registration Form" - New York (Haitian Creole)](https://data.templateroller.com/pdf_docs_html/2067/20673/2067386/page_1_thumb.png "Form AL500HC "Field Registration Form" - New York (Haitian Creole)")
1![Form AL500HC "Field Registration Form" - New York (Haitian Creole), Page 2](https://data.templateroller.com/pdf_docs_html/2067/20673/2067386/page_2_thumb.png "Form AL500HC "Field Registration Form" - New York (Haitian Creole), Page 2")
2Divizyon Règleman Imigran ak
Zafè Pwogram Travay Agrikilti
877-466-9757
Fòm Enskripsyon Agrikòl.
* Enfòmasyon demande
Dat:
Chèchè Djòb
*Prenon ________________________M.I ____*Siyati_______________________________Dat Anivèsè: _____ /_____ / _________
*Adrès Ri
# Apt.
*Vil
*Eta
*Kòd Postal ____________
Komin________________
Telefòn (_______) _______ - _________ Mobil (________) _______ - _________ Imel____________________________________
*Èske ou se Sitwayen Ameriken?
Non
Wi # Sekirite Sosyal _______ - _____ - _________
*Si se pa sa, èske ou otorize pou w travay Ozetazini?
Non
Wi, Nimewo Anrejistreman Alien ________________________
Èske ou gen yon lang prefere lòt pase Angle?
Non
Wi ____________________________________
*Eske ou se travayè Agrikòl?
Non
Wi Tcheke youn nan bagay sa yo:
Travayè Agrikòl Migran (deplase soti nan fèm nan jaden)
Pwosesè Manje Migran
Travayè Agrikòl Sezonye
Travayè Agrikòl pandan tout ane a
Istwa Travay
Ekri de dènye anplwayè yo pou moun ou te travay yo. Antre nan travay ki pi resan an premye. Ranpli tout atik yo mande pou chak patwon.
Mete tout detay posib pou amelyore chans pou nou ede ou jwenn travay.
Tit Djòb
Anplwayè
Adrès ______________________________________ Telefòn ________________________________________________
Vil ______________________________________Eta
Peyi, si se pa Etazini.
Dat kòmanse (mwa/ane) _____ / _________ dat fini (mwa/ane) _____ / _________
Salè $ ____________ pa
èdtan /
jou /
semèn /
mwa /
ane /
salè pou chak pyès ______________________
Konbyen èdtan pa semèn ou te travay?
Rezon ki fè wap kite ____________________________________________________________________________________
Tach Djòb
_
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Tit Djòb
____ Anplwayè
Adrès ____________________________________ Telefòn ____________________________________________________
Vil _________________________________________Eta
Peyi, si se pa Etazini.
Dat kòmanse (mwa/ane) _____ / _________ dat fini (mwa/ane) _____ / _________
Salè $ ____________ pa
èdtan /
jou /
semèn /
mwa /
ane /
salè pou chak pyès ______________________
Konbyen èdtan pa semèn ou te travay?
Rezon ki fè w kite
Tach Djòb
AL 500HC (10/19)
Paj 1 nan 2
Divizyon Règleman Imigran ak
Zafè Pwogram Travay Agrikilti
877-466-9757
Fòm Enskripsyon Agrikòl.
* Enfòmasyon demande
Dat:
Chèchè Djòb
*Prenon ________________________M.I ____*Siyati_______________________________Dat Anivèsè: _____ /_____ / _________
*Adrès Ri
# Apt.
*Vil
*Eta
*Kòd Postal ____________
Komin________________
Telefòn (_______) _______ - _________ Mobil (________) _______ - _________ Imel____________________________________
*Èske ou se Sitwayen Ameriken?
Non
Wi # Sekirite Sosyal _______ - _____ - _________
*Si se pa sa, èske ou otorize pou w travay Ozetazini?
Non
Wi, Nimewo Anrejistreman Alien ________________________
Èske ou gen yon lang prefere lòt pase Angle?
Non
Wi ____________________________________
*Eske ou se travayè Agrikòl?
Non
Wi Tcheke youn nan bagay sa yo:
Travayè Agrikòl Migran (deplase soti nan fèm nan jaden)
Pwosesè Manje Migran
Travayè Agrikòl Sezonye
Travayè Agrikòl pandan tout ane a
Istwa Travay
Ekri de dènye anplwayè yo pou moun ou te travay yo. Antre nan travay ki pi resan an premye. Ranpli tout atik yo mande pou chak patwon.
Mete tout detay posib pou amelyore chans pou nou ede ou jwenn travay.
Tit Djòb
Anplwayè
Adrès ______________________________________ Telefòn ________________________________________________
Vil ______________________________________Eta
Peyi, si se pa Etazini.
Dat kòmanse (mwa/ane) _____ / _________ dat fini (mwa/ane) _____ / _________
Salè $ ____________ pa
èdtan /
jou /
semèn /
mwa /
ane /
salè pou chak pyès ______________________
Konbyen èdtan pa semèn ou te travay?
Rezon ki fè wap kite ____________________________________________________________________________________
Tach Djòb
_
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Tit Djòb
____ Anplwayè
Adrès ____________________________________ Telefòn ____________________________________________________
Vil _________________________________________Eta
Peyi, si se pa Etazini.
Dat kòmanse (mwa/ane) _____ / _________ dat fini (mwa/ane) _____ / _________
Salè $ ____________ pa
èdtan /
jou /
semèn /
mwa /
ane /
salè pou chak pyès ______________________
Konbyen èdtan pa semèn ou te travay?
Rezon ki fè w kite
Tach Djòb
AL 500HC (10/19)
Paj 1 nan 2
Preferans Djòb
Kisa w ap chèche ________________________________________________________________________________________
Ki kalite travay ki akseptab?
Travay Semèn
Dirasyon (kantite tan travay)
A plen tan (30 èdtan. Pou chak semèn oswa plis)
Regilye
A tan pasyèl (mwens pase 30 èdtan. Chak semèn)
Sezonye/Tanporè
Nenpòt
Nenpòt
Salè minimòm akseptab egzije a $ ________________. _____ pa
Lè
Jou
Semèn
Mwa
Ane
Lòt
Ki orè ou vle travay? Tcheke tout sa ki aplikab:
Premye (Yon orè ki kòmanse nan maten)
Dezyèm (Yon orè ki kòmanse nan apremidi a/bonè nan aswè)
Twazyèmman (Orè ki kòmanse nan nwit)
Orè Travay
altène
Nenpot
Edikasyon, Sètifikasyon, Lisans
* Ki nivo edikasyon ki pi wo ou konplete?
Lekòl Segondè oswa GED
Fakilte
Lòt ______________________________
Èske ou gen yon diplòm avanse, diplòm oswa sètifika edikasyon?
Wi
Non
Domèn Etid
Diplom
Dat konplete (mwa/ane) _____ / _________
Enstitisyon ki delivre li
Eta
Peyi
_____
Èske ou gen yon sètifika oswa lisans okipasyonèl?
Wi
Non
Sètifika/Lisans
Òganizasyon oswa lokalite ki bay li
Dat delivre: (mwa. /ane.) _____ / _________ Eta
Peyi
Sètifika/Lisans Adisyonèl
Òganizasyon oswa lokalite ki bay li
Dat delivre: (mwa. /ane.) _____ / _________ Eta
Peyi
Èske w ale nan yon lekòl segondè, pwofesyonèl, teknik oswa akademik atan plen? (12 èdtan oswa plis)
Wi
Non
Si ou nan mitan tèm, ou gen entansyon retounen nan lekòl la?
Wi
Non
Ou gen yon lisans chofè?
Wi
Non
Eta ki bay li a:
Ki kalite lisans ou genyen?
Klas A (traktè trelè)
klas B (Kamyon/Bis
Klas C (Kamyon Lejè komèsyal)
Klas Cn Kamyon ki pa CDL
Klas (Operatè)
Klas E (Taksi)
Klas M (Motosiklèt)
Andosman:
Transpò pasaje
Materyèl danjre
Machin Tank
Motosiklèt
Bis lekòl
Doub/Trip
Tank danje
Fren ak lè
Èske w gen yon machin ki disponib pou transpò pou ale ak sòti nan travay?
Wi
Non
Konpetans
Fè lis konpetans ou ak kapasite ou te itilize nan travay ou (yo) oswa ou te aprann nan lekòl oswa nan fòmasyon. Egzanp yo se chapant,
soude, operasyon ekipman fèm, kondwi traktè, patinen trennen oswa chèn wè operasyon, konstriksyon, PTO, jaden, reparasyon motè,
masonry, kwit manje / restoran travay, sezisman oswa ladrès òdinatè.
Ekri tout lang ou pale ak/oswa ekri kouramman
Depatman Travay Eta New York se yon Anplwaye Opòtinite Egal.
Si rekòmande, èd ak sèvis oksilyè pwogram yo apwovizyone bay moun ki gen andikap
AL 500HC (10/19)
Paj 2 nan 2
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