OPT Reporting Form

Part I: Personal Information

First Name*

Last Name*

Today's Date*

SEVIS ID Number*

Phone Number*

Email Address*

Current Residential Address*

Current Foreign Address*

If you have just received your Employment Authorization Document (EAD) and have not yet completed this survey, please submit a copy of both sides of your EAD to the Office of International Student Services at oie@esf.edu. If you are unsure if this is your first time, please submit a copy. If you have already taken this survey before, continue on to the rest of the form.
Part II: Prior Employment Information

Prior Employment NamePlease add full name

Prior Employer's EIN Number

Position Title at Prior Employer

Is this work

Full Time (more than 20 hr/week)

Part Time (20 or less hr/week)

Employment Start Date at Prior Employer

Employment End Date at Prior Employer

Prior Employer Address

Part III: Current Employment Information

Current Employer Name:*

Current Employer's EIN Number

Position Title at Current Employer*

Employment Start Date at Current Employment*

Is this work?*

Full Time (more than 20 hr/week)

Part Time (20 or less hr/week)

Current Employer Stree Address*

Current Employer City*

Current Employer Zip Code

Part IV: Supervisor Information

Supervisor's Name*

Supervisor's Title*

Supervisor's Phone Number*

Supervisor's Email Address*

How does this work relate to your major?*

Part V: Other Information

Have you changed to another visa status meaning that you are no longer in F-1 visa status?*

Yes

No

Have you legally changed your name?*

Yes

No

If you have any questions regarding the form or your employment, please contact the Office of International Student Services at 315-470-4754 or oie@esf.edu so that we may assist you

SUNY ESF OPT Reporting Form

SUNY ESF
OPT Reporting Form