Center for International Career Development
Work and Travel Program
4530 Union Bay Place NE, Suite 214
Seattle WA 98105, USA
Phone: 206-957-7115, Fax: 206-527-0338
E-mail: swt@cicdgo.com, Web: www.cicdgo.com
Work & Travel Employment Verification Form
1. Summer Work & Travel Applicant Information
| Applicants Last Name | Vilche | Birth date | 02/26/2007 |
| Applicants First Name | Nathalie | Nationality | Chilean |
2. Host Company Information
| U.S. Host Company Name | Ted’s Montana Grill, LLC | ||||
| Address; Street Number | 2200 Crystal Drive, Suite A | ||||
| City | Arlington | State | VA | Zip Code | 22202 |
| Phone Number | 703-416-8337 | Fax | 703-416-4615 | ||
| Supervisor’s Name | Fabiano Pinno Pessoa | ||||
| Supervisor’s Position | Manager | Supervisor’s Phone Number | 703-416-8337 | ||
| Email Address | Website | ||||
| Has your Company employed Work and Travel Participants before? | Yes | ||||
3. Job Information
| Job Start Date (mm/dd/yy) | 12/15/2007 | Job End Date (mm/ddd/yy) | 4/15/2008 | |
| Flexible Start and End Dates | Yes. Can start as late as Januray | |||
| Job Title | Hostess Primary/Waitress | |||
| Job Description | Greet guests, take reservations, assist guests. Waitress explains menu, takes orders, serves | |||
| Expected hours per Week | 35 | Minimum Hours per Week | 25 | |
| Wages | $9.00 hostess. $2.13 waitress | Per | Hour | |
| Tips Available? | Yes | Bonuses? | Secret Shopper Perfect Score $50 Bonus | |
| Is this the same compensation received by U.S. Citizens in the same position? | Yes | |||
| Overtime Available? | No | Overtime Pay Available | $ | |
| Frequency of Pay Checks | Bi-weekly | Uniform Required? | Yes, jeans and white shirt | |
| Is the Uniform Provided? | No | Cost of the Uniform | $30 | |
| Drug Test Required? | Only if injured on the job | If so, how often? |
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| Additional Information |
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4. Housing Information
5. Host Company Agreement
| The Applicant hereby certifies and agrees that he/she has reviewed all of the information provided in this and other Work and Travel documents, and that the Applicant accepts these terms and conditions and agrees to work for the Host Company for the time period described to the best of his/her ability, and should either the Applicant or the Host Company alter these dates of employment or terminate the employment for any reason, the Applicant agrees to give immediate written notification of this change to CICD and acknowledges and expressly accepts that failure to do so, or failure to complete the check in process required by CICD within two weeks of the employment start date above is grounds for and may result in immediate termination of his/her visa status. The Applicant also acknowledges and agrees that his/her duties and responsibilities may vary during the period of employment, that the employment offered is "at will" and can be terminated at any time and for any reason by either the Applicant, Host Company or CICD, and that the Employment Verification is in no way an employment or staffing contract between the Applicant and CICD. I understand and agree that all information disclosed to me by CICD and/or its partners and representatives shall be deemed confidential and used only for the purposes of sponsoring my Work and Travel experience through CICD exclusively, and shall not be used in any other manner whatsoever, disclosed to others, used to apply for DS2019 forms and/or program sponsorship through any other sponsor organizations whatsoever, except through CICD, copied or reproduced by me for any purpose without first obtaining written permission from CICD.
Signature of Applicant Date Place signed
Printed Name of Applicant |
| 1. Host Company Verification: The Host Company above hereby certifies and agrees that its authorized representative has thoroughly reviewed all of the program information provided in this and other Work and Travel documents. The Host Company hereby certifies and agrees that all of the information provided in this document is true and correct, that the Host Company has offered the Applicant (named above) the described employment "at will". This Employment Verification serves to document the employment offer the Host Company has extended to the Work and Travel Applicant named above, so that all parties are fully aware of the terms of this employment offer, and that the Applicant named above is eligible for consideration by CICD for visa sponsorship on the Work and Travel Program. 2. Host Company Responsibilities: The Host Company agrees to notify CICD immediately and in writing (email) in the event that the applicant fails to arrive at the Host Company to begin employment, and also to notify CICD if the applicant leaves the employ of the Host Company for any reason, whether voluntarily or not. The Host Company understands that given human nature, a certain percentage of participants, which may include this Work and Travel participant, will not succeed in fulfilling expectations of this position, and that the Host Company will not hold CICD or any other persons connected therewith liable in any way for any such shortcomings, or CICD’s decision to terminate this Work and Travel participant's employment. The Host Company is required to provide to each respective Work and Travel student the Work and Travel employment/position as described in the respective CICD-Host Company contract(s), as well as on the first day of employment to instruct each Work and Travel student to officially CHECK IN with CICD to validate their program and receive their CICD orientation. Place all participants who are in Host Company-arranged housing only in conditions and neighborhoods or areas that are known to be safe and that do not expose participants to unreasonable risks to personal safety during travel to or from the housing. Partner also agrees to immediately move at its own expense any participant(s) who may for any reason be placed in substandard, unclean or unsafe housing as is reasonably expected by American citizens living in/near the work vicinity of the Host Company. 3. Arbitration and Choice of Law: For any dispute, difference, or disagreement that arises upon or in respect of this Employment Verification and the meaning and construction hereof, and to which CICD and the Host Company cannot themselves agree to a mutually agreeable solution, every such dispute, difference, and disagreement shall be referred to a single arbiter agreed upon by the parties, or if no single arbiter can be agreed upon, an arbiter or arbiters shall be selected in accordance with the rules of the American Arbitration Association. Choice of Law: All disputes arising under or out of this document shall be governed by and resolved in accordance with the laws of the State of Washington, USA. No other law shall be applicable. Any lawsuit arising out of this document, or in connection with this document in any manner, may only be brought in King County, Washington, USA. 4. Visa Application: The Host Company understands that U.S. Government agencies having jurisdiction over immigration matters exercise sole discretion in administering their responsibilities, and therefore CICD makes no claim or representation with respect to the likelihood of success in any visa application or the time in which a particular application may be processed. 5. Hold Harmless: The Host Company understands that CICD cannot guarantee or assure that there may not be problems or challenges which may lead to the expulsion, firing, dismissal or termination of program participation of the Work and Travel applicant named above at the sole judgment and discretion of CICD. The Host Company understands and accepts that CICD is the visa Sponsor organization and can in no way be construed to be the employer of the Work and Travel participant in the US. The Host Company named in the table at the top of this contract is the employer for the duration of the employment. The Host Company does hereby promise, undertake and guarantee to hold harmless and to indemnify CICD and all other persons connected with the Work and Travel program from all liabilities, claims, actions, damages, expenses and losses of any nature whatsoever caused by or arising from any aspect of the program and all other persons connected with the program. The Host Company hereby states and affirms that the conditions of employment, any contractual or financial obligations, and expectations have been presented and explained to the Work and Travel applicant's full and complete understanding and satisfaction and that it is voluntarily offering this temporary, at-will employment to the above-named applicant and /or participant in this Work and Travel program, and that the offered wage corresponds to the same compensation (salary and benefits) that U.S. citizens receive in the same position.
Signature of Host Company Contact as Authorized Representative of Host Company Date Place signed
Printed Name of Host Company Contact above |
6. Work and Travel Applicant Agreement
