Office of Foreign Labor Certification J Employment and Training Administration - ETA 2) A Application for the United States International Labor Certification nN ys U.S. Labor Continental Agency SE TES 150, 151 Rue J. Gomis, Dakar, Senegal Applicant must carefully fill the below columns provided in this application form with accurate information, It is advisable to use a pen in filling out the form. Alphabets must be written in capital form. Tick where applicable. Note: separate application is required for each person applying for his or her certificate. Partners and dependent such as children must complete individual application form SECTION 1 (a): APPLICANT'S DETAILS bb MM. vyyy M E SECTION 1 (b): APPLICANT'S IDENTITY DOCUMENT Details of any government issued identification card such as national identity card, driver's license, voter's cardor your international travel passport. bb MM. vvvy bb MM. vyvy Marital status: Single(_] Married[_] _Divorced[—]_ widowed] _ ma relationship [] Your residential address. Note: post office box address is not acceptable as a residential address. Failure to give your full and accurate residential address may invalidate your AS SECTION 2: NEXT OF KIN/REFERENCESECTION 3: EMPLOYER IN THE USA pp MM. yyyy SECTION 4: CHARACTER CHECKS a) Have you ever been convicted of a crime or offence in the United States that prompted 2 years jail term or more? Yes [_] No [_] b) Have you ever been repatriated or deported from the United States? Yes[_] _ NoL_] c) Have you ever granted? Yes! inal offence for which a pardon has not been 4) Do you have any outstanding debt to pay to any government or public organization in the United States? Yes! e) Have you ever served in the military or trained in the use of explosive materials? Yes|_] Ne f) Have you ever been involved or convicted pt offence relating to illegal movement of people, human and drug trafficking? Yes! Ifyou answer 'YES' to any of these above questions, kindly provide all the relevant details. Ifthe spaces given are not enough, attach an additional statement. WARNING: Note: any information on this application including employment details will be well investigated therefore, giving false information or irrelevant information on this form is a serious offence punishable by law and bound to nullify this application. SECTION 5: DECLARATION Thereby declare that all the information that I wrote on this form is authentic to the best of my knowledge.