Independent Student Job Offer Form
Intrax is designated by the U.S. Department of State as an authorized sponsor of the Summer Work and Travel program, a program that provides foreign
students with an opportunity to live and work in the United States during their summer vacation from college or university to experience and to be exposed to
the people and way of life in the United States. For more information on this program please visit http://j1visa.state.gov/programs/summer-work-travel/ or
http://intraxusa.com/work-travel. Intrax is required to adequately vet all potential host employers to confirm that job offers are viable. You will be
contacted by an Intrax representative to verify information about the employment of the student mentioned below.
Student Last Name:
Student First Name:
Intrax ID:
Host Company Information (to be completed by Host Company)
Company Name:
Main Phone:
Street Address:
City
Are you a staffing agency?
Address where work will take place (if different from above)
Website:
State
Zip
City
State
Zip
EIN/Tax ID:
Workman’s Compensation Insurance Policy Number:
Carrier:
If your company is exempt from providing Workman’s Compensation Insurance, please indicate why:
Hiring Manager Information (who we should contact to confirm employment)
Hiring Manager Name:
Phone:
Title:
Ext.
Email:
Alternate Phone:
Ext.
Best time to reach:
Job Information
Job Title:
Pay Rate Per Hour:
Approximate hours per week:
Description of Duties:
Job Start Date:
Job End Date:
Important Information for Host Companies
In hiring an Intrax Work and Travel student you understand and agree to the following Host Company obligations:

You will provide the number of hours of paid employment per week as identified in this job offer.

You will pay the student eligible for overtime in accordance with state or federal law, and will comply with all local, state, and federal labor laws.

You will notify Intrax promptly when a student arrives at the work site to begin their program; when there are any changes or deviations in the job
placement; when student is not meeting the requirements of their job placements; or when student leaves their position ahead of their planned
departure.

You will notify Intrax immediately in the event of any emergency involving the student or any situation that impacts the welfare of the student.

You understand that Intrax does not guarantee visa approval, arrival date or departure date of the student.

You understand that the student is not an employee, agent or independent contractor of Intrax, and that Intrax does not exercise dominion or control
over actions of the students. Intrax is not responsible for any act or omission on the part of the student. You agree that any decision regarding a student’s
program status will be made at the sole discretion of Intrax.

You reserve the right to dismiss the student at will, but agree to make a good faith effort to retain the student as long as assigned duties are performed
at a satisfactory level.

You will not employ participants in any of the following jobs: Au pair, nanny, babysitting, domestic labor, crew member on ships or airplanes, or as pilots,
sales jobs involving purchasing merchandise to resell (door-to-door sales), employment through staffing agencies, camp counselor, teacher, coach,
medical / veterinary / pharmaceutical services / jobs that require direct patient contact or dispensing of medication, Adult Entertainment, positions that
are substantially commission-based, thereby not guaranteeing minimum wage for all hours worked, pedicab or rolling chair drivers or operators, operators
of vehicles or vessels that carry passengers for hire and/or for which commercial driver’s licenses are required, independent contractors, unpaid interns,
any job that could bring notoriety or disrepute to the Exchange Visitor Program.

You agree that if housing is provided by the company, it will be safe, comfortable and comply with local, state and federal housing codes and regulations.

You understand that Intrax can be reached by contacting us at 1-888-224-0450 or [email protected].
I confirm that I am an employee of the above mentioned company with authority to verify employment information.
Authorized Host Company Signature:
Title:
Authorized Name (Print):
Date:
Student Signature:
Date:
Intrax Work Travel - http://intraxusa.com/work-travel
IWT-09/16/11 –IPA