I-765 Application Form I-765 Application for Employment Authorization Back Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.What is your reason for applying? *First permission to accept workReplacement of lost, stolen or damaged work authorization documents or correction of my work authorization documents NOT DUE TO USCIS error.Renewal of permission to accept workHave you already filed Form I-765? *YesNoWill someone help you fill out this application? *YesNoWhat is your current legal name? *FirstLastHave you used any other name since birth?YesNoHow can we contact you? LayoutDaytime phone number *Mobile Phone number(if any)Email Address *What is your current US mailing address? *Is your current mailing address the same as your physical address? *YesNoWhat is your gender? *MaleFemaleWhat is your marital status? *SingleMarriedDivorcedWidowedWhat city, town, or village were you born in? *What is your state or province of birth? *What country are you born in? *What is your date of birth? *What is your country of citizenship or nationality? *What is your Form I-94 Arrival-Departure Record Number (if any)?When was the last time you arrived in the United States? LayoutDate of arrival *Place of arrival *Status of last arrival *What is the passport number of your last issued passport? *What is your travel document number (if any)? *What is the expiry date of your passport or travel document? *Which country issued your passport or travel document? *What is your current immigration status or category? *What is your Student and Visitor Information System (SEVIS) Number (if any)?What is your A number? *Has the Social Security Administration (SSA) ever given you an official Social Security card? *YesNoDo you want the SSA to issue you a Social Security card? *YesNoI-821, Application for Temporary Protected Status.Evidence Layout I-94 Upload your file here Passport Upload your file here 2x2 Passport Photo Upload your file here Church Records or School Records Upload your file hereOther DocumentsSubmit
