CIEE Work & Travel USA

Job Offer Form: Winter 2017

Work & Travel Employer Section
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HEYDI CUTISACA ITO

Employer & Job

15315480181C

Nordic Village

INTEJ
7 DE JUNIO H-4 , 54
PERU

Route 16
Jackson, NH 03846

heydi_1_138@hotmail.com
Female

Work Dates:
Thursday, December 15, 2016
Monday, March 27, 2017

WC: Memic Indemnity Company 5101800362

Contact Name: Shawn Ford
Phone:

603.383.9101

Email:

shawnfordoffice@gmail.com

Job Details:
Housekeeper
$ 8.25 Per Hour
Average Hours per Week:
Housing Provided:
Housing Cost:

32

YES

$ 65.00 Per Week

End of Season Bonus:

No

Employer Signature

Work & Travel Participant Section

By signing below, I indicate my understanding and agreement with the following terms: 1. This job has been sourced by CIEE; therefore I am bound by CIEE rules and J-1 Visa regulations. 2. Any
position offered to me is not a firm, irrevocable offer and may be revoked at any time before I commence employment. In the event that the employer revokes this offer, CIEE will assist me in my effort
to find alternative employment, but CIEE makes no guarantee that its effort will be successful. I will be an employee-at-will, and my employment relationship may be terminated at any time by the
employer. 3. I fully understand the job offered above. I have reviewed all information related to this position, as provided to me by the employer and/or CIEE Representative, including the full job profile.
The terms above are general in nature and my hours, duties, and housing are subject to change. I will report to the employer listed above within five days of arrival in the United States. I will work for a
period that will not exceed the end date on my DS-2019 form. 4. I will adhere to all CIEE and CIEE Representative rules regarding employment and program participation, including the Terms and
Conditions / Participant Declaration which forms part of my program application. Once I have accepted this job, I am committed to stay at this place of employment for the duration of the program. If I
wish to change employers, I must receive permission from both CIEE and my CIEE Representative prior to doing so. Should I change jobs without receiving prior permission from CIEE and my CIEE
Representative, or if I violate other CIEE rules, CIEE may terminate its sponsorship of me and I will be required to return home. I also understand that such termination may prevent me from receiving
future U.S. visas.

Participant Signature
Name: HEYDI CUTISACA ITO

Date:

**THE PARTICIPANT MUST SEND THE ORIGINAL SIGNED AGREEMENT TO THEIR CIEE REPRESENTATIVE**
**THE PARTICIPANT MUST ALSO SEND A COPY TO THE EMPLOYER AND KEEP A COPY FOR THEIR OWN RECORDS**