Rutgers Biomedical and Health Sciences International Services
Complete this form and send via e-mail, fax or mail to:
Office of International Services, 65 Bergen Street, Room GA-72 Newark, NJ 07101
973-972-6138 (phone) 973-972-8260 (fax)
OPT Employment Update Form
This form is to be completed by any F-1 student on OPT who is starting, changing or ending employment.
For information about OPT reporting visit our website.
CONTACT INFORMATION
Family name
First name
Number and Street
Apt #
City/Town
State
Home #
Cell #
E-mail address
Zip code
Work #
Alternate E-mail address
EMPLOYMENT INFORMATION
Employment Status
New Employment
No Employment
Change of Employment
Note for Employment Status: If you are unemployed or are changing employment and will be unemployed for longer than 10 days,
please select "No Employment". If you are changing employers and will be unemployed for fewer than 10 days, please select "Change of
Employment".
Type of Employment
Single Employer
Multiple Employers
Self-employed
Volunteer Position
Note for Type of Employment: If you have MULTIPLE EMPLOYERS (more than 1), please attach a copy of this form for each individual
employer. Indicate which employer is the primary (more hours) employer. UNPAID EMPLOYMENT: If you have unpaid employment,
please indicate whether you have a single unpaid position or multiple positions.
Name of Employer
Job Title
Location of Employment
Number and Street
City
State
Zip Code
Telephone Number
Name of Supervisor
Supervisor Phone #
Supervisors E-mail Address
Start Date of Employment
End Date of Employment
Relevance to Program (max 3-4 sentences):
*Federal regulations require all F-1 students on OPT to inform the International Services office of any change in employment. The Office of International Services
recommends that students report within 10 days of any change . We also ask that you report any change of immigration status within 10 days .
Revised: 3/2016
Please complete this form and e-mail, fax or mail to the Office of International Services
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