Form I 765 Application For Employment

Summary

Application For Employment Authorization USCIS
Form I-765
Department of Homeland Security OMB No. 1615-0040
U.S. Citizenship and Immigration Services Expires 10/31/2025
Authorization/Extension Fee Stamp Action Block
Valid From
Authorization/Extension
For Valid Through
USCIS
Use
Only
Alien Registration Number A-
Remarks
To be completed by an attorney or Select this box if Form G-28 Attorney or Accredited Representative
Board of Immigration Appeals (BIA)- is attached. USCIS Online Account Number (if any)
accredited representative (if any)

► START HERE - Type or print in black ink

Part 1. Reason for Applying Other Names Used
I am applying for (select only one box): Provide all other names you have ever used, including aliases,
maiden name, and nicknames. If you need extra space to
1.a. Initial permission to accept employment

complete this section, use the space provided in Part 6

1.b. Replacement of lost, stolen, or damaged employment Additional Information

authorization document, or correction of my
2.a. Family Name
employment authorization document NOT DUE to (Last Name)
U.S. Citizenship and Immigration Services (USCIS) 2.b. Given Name
error. (First Name)
NOTE: Replacement (correction) of an employment 2.c. Middle Name
authorization document due to USCIS error does not
require a new Form I-765 and filing fee. Refer to
3.a. Family Name
Replacement for Card Error in the What is the (Last Name)
Filing Fee section of the Form I-765 Instructions for 3.b. Given Name
further details. (First Name)
1.c. Renewal of my permission to accept employment. 3.c. Middle Name
(Attach a copy of your previous employment
authorization document.)
4.a. Family Name
(Last Name)
4.b. Given Name
Part 2. Information About You (First Name)
4.c. Middle Name
Your Full Legal Name
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name
Form I-765 Edition 10/31/22 Page 1 of 7
Part 2. Information About You (continued) 13.b. Provide your Social Security number (SSN) (if known)

►
Your U.S. Mailing Address 14. Do you want the SSA to issue you a Social Security card?
(You must also answer “Yes” to Item Number 15.,
5.a. In Care Of Name (if any) Consent for Disclosure, to receive a card.)
Yes No
5.b. Street Number
and Name NOTE: If you answered “No” to Item Number 14., skip
to Part 2., Item Number 18.a. If you answered “Yes” to
5.c. Apt. Ste. Flr. Item Number 14., you must also answer “Yes” to Item
Number 15

5.d. City or Town
15. Consent for Disclosure: I authorize disclosure of
5.e. State 5.f. ZIP Code information from this application to the SSA as required
for the purpose of assigning me an SSN and issuing me a
(USPS ZIP Code Lookup)
Social Security card. Yes No
6. Is your current mailing address the same as your physical
address? Yes No NOTE: If you answered “Yes” to Item Numbers
14. - 15., provide the information requested in Item
NOTE: If you answered “No” to Item Number 6., Numbers 16.a. - 17.b

provide your physical address below

Father's Name
U.S. Physical Address Provide your father's birth name

16.a. Family Name
7.a. Street Number (Last Name)
and Name
16.b. Given Name
7.b. Apt. Ste. Flr. (First Name)
7.c. City or Town Mother's Name
Provide your mother's birth name

7.d. State 7.e. ZIP Code
17.a. Family Name
(Last Name)
Other Information 17.b. Given Name
(First Name)
8. Alien Registration Number (A-Number) (if any)
► A-
Your Country or Countries of Citizenship or
9. USCIS Online Account Number (if any) Nationality
► List all countries where you are currently a citizen or national

If you need extra space to complete this item, use the space
10. Gender Male Female provided in Part 6. Additional Information

11. Marital Status 18.a. Country
Single Married Divorced Widowed
12. Have you previously filed Form I-765? 18.b. Country
Yes No
13.a. Has the Social Security Administration (SSA) ever
officially issued a Social Security card to you?
Yes No
NOTE: If you answered “No” to Item Number 13.a.,
skip to Item Number 14. If you answered “Yes” to Item
Number 13.a., provide the information requested in Item
Number 13.b

Form I-765 Edition 10/31/22 Page 2 of 7
Part 2. Information About You (continued) Information About Your Eligibility Category
27. Eligibility Category. Refer to the Who May File Form
Place of Birth I-765 section of the Form I-765 Instructions to determine
the appropriate eligibility category for this application

List the city/town/village, state/province, and country where
Enter the appropriate letter and number for your eligibility
you were born

category below (for example, (a)(8), (c)(17)(iii))

19.a. City/Town/Village of Birth ( )( )( )
28. (c)(3)(C) STEM OPT Eligibility Category. If you
19.b. State/Province of Birth entered the eligibility category (c)(3)(C) in Item Number
27., provide the information requested in Item Numbers
28.a - 28.c

19.c. Country of Birth
28.a. Degree
28.b. Employer's Name as Listed in E-Verify
20. Date of Birth (mm/dd/yyyy)
28.c. Employer's E-Verify Company Identification Number or a
Information About Your Last Arrival in the Valid E-Verify Client Company Identification Number
United States
21.a. Form I-94 Arrival-Departure Record Number (if any)
29. (c)(26) Eligibility Category. If you entered the eligibility
► category (c)(26) in Item Number 27., provide the receipt
number of your H-1B spouse's most recent Form I-797
21.b. Passport Number of Your Most Recently Issued Passport
Notice for Form I-129, Petition for a Nonimmigrant
Worker

21.c. Travel Document Number (if any) ►
30. (c)(8) Eligibility Category. If you entered the eligibility
category (c)(8) in Item Number 27., have you EVER
21.d. Country That Issued Your Passport or Travel Document
been arrested for and/or convicted of any crime?
Yes No
21.e. Expiration Date for Passport or Travel Document
NOTE: If you answered “Yes” to Item Number 30.,
(mm/dd/yyyy) refer to Special Filing Instructions for Those With
Pending Asylum Applications (c)(8) in the Required
22. Date of Your Last Arrival Into the United States, On or
Documentation section of the Form I-765 Instructions
About (mm/dd/yyyy)
for information about providing court dispositions

23. Place of Your Last Arrival Into the United States 31.a. (c)(35) and (c)(36) Eligibility Category. If you entered
the eligibility category (c)(35) in Item Number 27., please
provide the receipt number of your Form I-797 Notice for
24. Immigration Status at Your Last Arrival (for example, Form I-140, Immigrant Petition for Alien Worker. If you
B-2 visitor, F-1 student, or no status) entered the eligibility category (c)(36) in Item Number
27., please provide the receipt number of your spouse's or
parent's Form I-797 Notice for Form I-140

25. Your Current Immigration Status or Category (for example, ►
B-2 visitor, F-1 student, parolee, deferred action, or no
status or category) 31.b. If you entered the eligibility category (c)(35) or (c)(36) in
Item Number 27., have you EVER been arrested for
and/or convicted of any crime? Yes No
26. Student and Exchange Visitor Information System
(SEVIS) Number (if any) NOTE: If you answered “Yes” to Item Number 31.b.,
► N- refer to Employment-Based Nonimmigrant Categories,
Items 8. - 9., in the Who May File Form I-765 section
of the Form I-765 Instructions for information about
providing court dispositions

Form I-765 Edition 10/31/22 Page 3 of 7
Part 3. Applicant's Statement, Contact Applicant's Declaration and Certification
Information, Declaration, Certification, and Copies of any documents I have submitted are exact photocopies
Signature of unaltered, original documents, and I understand that USCIS
may require that I submit original documents to USCIS at a later
NOTE: Read the Penalties section of the Form I-765 date. Furthermore, I authorize the release of any information
Instructions before completing this section. You must file from any and all of my records that USCIS may need to
Form I-765 while in the United States. determine my eligibility for the immigration benefit that I seek

Applicant's Statement I furthermore authorize release of information contained in this
application, in supporting documents, and in my USCIS
NOTE: Select the box for either Item Number 1.a. or 1.b. If records, to other entities and persons where necessary for the
applicable, select the box for Item Number 2. administration and enforcement of U.S. immigration law

1.a. I can read and understand English, and I have read I understand that USCIS may require me to appear for an
and understand every question and instruction on this appointment to take my biometrics (fingerprints, photograph,
application and my answer to every question. and/or signature) and, at that time, if I am required to provide
biometrics, I will be required to sign an oath reaffirming that:
1.b. The interpreter named in Part 4. read to me every
question and instruction on this application and my 1) I reviewed and understood all of the information
answer to every question in contained in, and submitted with, my application; and
, 2) All of this information was complete, true, and correct
a language in which I am fluent, and I understood at the time of filing

everything. I certify, under penalty of perjury, that all of the information in
2. At my request, the preparer named in Part 5., my application and any document submitted with it were
provided or authorized by me, that I reviewed and understand
, all of the information contained in, and submitted with, my
prepared this application for me based only upon application and that all of this information is complete, true, and
information I provided or authorized. correct

Applicant's Contact Information Applicant's Signature
3. Applicant's Daytime Telephone Number
7.a. Applicant's Signature
4. Applicant's Mobile Telephone Number (if any)
7.b. Date of Signature (mm/dd/yyyy)
NOTE TO ALL APPLICANTS: If you do not completely fill
5. Applicant's Email Address (if any)
out this application or fail to submit required documents listed
in the Instructions, USCIS may deny your application

6. Select this box if you are a Salvadoran or Guatemalan
national eligible for benefits under the ABC
Part 4. Interpreter's Contact Information,
settlement agreement

Certification, and Signature
Provide the following information about the interpreter

Interpreter's Full Name
1.a. Interpreter's Family Name (Last Name)
1.b. Interpreter's Given Name (First Name)
2. Interpreter's Business or Organization Name (if any)
Form I-765 Edition 10/31/22 Page 4 of 7
Part 4. Interpreter's Contact Information, Part 5. Contact Information, Declaration, and
Certification, and Signature Signature of the Person Preparing this
Application, If Other Than the Applicant
Interpreter's Mailing Address Provide the following information about the preparer

3.a. Street Number
and Name Preparer's Full Name
3.b. Apt. Ste. Flr. 1.a. Preparer's Family Name (Last Name)
3.c. City or Town
1.b. Preparer's Given Name (First Name)
3.d. State 3.e. ZIP Code
3.f. Province 2. Preparer's Business or Organization Name (if any)
3.g. Postal Code
3.h. Country Preparer's Mailing Address
3.a. Street Number
and Name
Interpreter's Contact Information 3.b. Apt. Ste. Flr

4. Interpreter's Daytime Telephone Number
3.c. City or Town
5. Interpreter's Mobile Telephone Number (if any) 3.d. State 3.e. ZIP Code
3.f. Province
6. Interpreter's Email Address (if any)
3.g. Postal Code
3.h. Country
Interpreter's Certification
I certify, under penalty of perjury, that:
Preparer's Contact Information
I am fluent in English and ,
which is the same language specified in Part 3., Item Number 4. Preparer's Daytime Telephone Number
1.b., and I have read to this applicant in the identified language
every question and instruction on this application and his or her
answer to every question. The applicant informed me that he or 5. Preparer's Mobile Telephone Number (if any)
she understands every instruction, question, and answer on the
application, including the Applicant's Declaration and
Certification, and has verified the accuracy of every answer. 6. Preparer's Email Address (if any)
Interpreter's Signature
7.a. Interpreter's Signature
7.b. Date of Signature (mm/dd/yyyy)
Form I-765 Edition 10/31/22 Page 5 of 7
Part 5. Contact Information, Declaration, and
Signature of the Person Preparing this
Application, If Other Than the Applicant
(continued)
Preparer's Statement
7.a. I am not an attorney or accredited representative
but have prepared this application on behalf of
the applicant and with the applicant's consent

7.b. I am an attorney or accredited representative and
my representation of the applicant in this case
extends does not extend beyond the
preparation of this application

NOTE: If you are an attorney or accredited
representative, you may need to submit a
completed Form G-28, Notice of Entry of
Appearance as Attorney or Accredited
Representative, with this application

Preparer's Certification
By my signature, I certify, under penalty of perjury, that I
prepared this application at the request of the applicant. The
applicant then reviewed this completed application and
informed me that he or she understands all of the information
contained in, and submitted with, his or her application,
including the Applicant's Declaration and Certification, and
that all of this information is complete, true, and correct. I
completed this application based only on information that the
applicant provided to me or authorized me to obtain or use

Preparer's Signature
8.a. Preparer's Signature
8.b. Date of Signature (mm/dd/yyyy)
Form I-765 Edition 10/31/22 Page 6 of 7
Part 6. Additional Information 5.a. Page Number 5.b. Part Number 5.c. Item Number
If you need extra space to provide any additional information
within this application, use the space below. If you need more 5.d

space than what is provided, you may make copies of this page
to complete and file with this application or attach a separate
sheet of paper. Type or print your name and A-Number (if any)
at the top of each sheet; indicate the Page Number, Part
Number, and Item Number to which your answer refers; and
sign and date each sheet

1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name 6.a. Page Number 6.b. Part Number 6.c. Item Number
2. A-Number (if any) ► A-
6.d

3.a. Page Number 3.b. Part Number 3.c. Item Number
3.d

7.a. Page Number 7.b. Part Number 7.c. Item Number
7.d

4.a. Page Number 4.b. Part Number 4.c. Item Number
4.d

Form I-765 Edition 10/31/22 Page 7 of 7

Provide the receipt number of your Form I-797 Notice for Form I-140, Immigrant Petition for Alien Worker. If you entered the eligibility category (c)(36) in Item Number 27., please provide the …

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Frequently Asked Questions

How to file i 765?

How to Fill I-765 form Online for OPT, STEM OPT?

1. Create USCIS Account. Create a USCIS account online at myaccount.uscis.gov. ...
2. Select "File a Form Online" Option
3. Select Application for Employment Authorization (I-765)
4. Info on Eligibility, Fee, Documents, Tracking, Validity
5. Getting Started - Eligibility, Reason, Preparer & Interpreter. ...
6. About You - Name, Contact, Immigration Info. ...

Who may file form i 765?

What is Form I-765? F-1 students who are in the United States may file the Form I-765: Application for Employment Authorization with U.S. Citizenship and Immigration Services (USCIS) to request certain employment authorizations and obtain an Employment Authorization Document (EAD).

Where to send form i 765?

For I-765 Application for Employment Information (such as Optional Practical Training (OPT), please use the following address: For U.S. Postal Service deliveries (including US Postal Service Express mail): USCIS PO Box 21281 Phoenix, AZ 85036 For Express mail and courier deliveries mail your application to:

Where to file i 765?

• Fill out simple EAD application form i765,
• Sign a personal check for $410,
• Attach supporting documents,
• Send it to USCIS. You are done.