Email: career@viu.edu Notification Form

1 Rev: 01/2020 EMPLOYMENT Notification form Submit this completed form no later than 90 days from the start date listed on you EAD Card, and within 10 days if employment status changes. Scan and email this form with the Employment Offer Letter to All FXUA graduates should submit this form regardless of their status (F-1, GC, citizens, ). Additionally, F-1 status graduates will need to update employment on the DSO website. 1 - PERSONAL INFORMATION (TO BE COMPLETED BY STUDENT) First: _____ Middle: _____ Last Name: _____ FXUA Student ID #_____ Degree and Program: _____ Graduation Date: ____/____/_____ (MM/DD/YYYY) Semester: Spring / Summer I / Summer II / Fall Address: _____ City: _____ State: _____ Zip Code: _____ Phone: _____ Personal Email: _____ Status: F-1* / H-1 / H-4 / K-1 / Green Card holder / US Citizen / Other: _____ *OPT Start Date: ____/____/_____ (MM/DD/YYYY) OPT End Date.

2 ____/____/_____ (MM/DD/YYYY) 2 - JOB PLACEMENT INFORMATION (TO BE COMPLETED BY STUDENT) Job Title: _____ Position Start Date: ____/____/_____ (MM/DD/YYYY) Work hours per week: _____ Salary per year $_____ (please put 0 if position is unpaid) Company Name: _____ E-Verify # (for F-1) _____ Employer Identification Number (EIN #) _____ Address: _____ City: _____ State: _____ Zip Code: _____ Supervisor s Name: _____ Title: _____ Supervisor s Phone: _____ Email: _____ List 4 skills you use in this position which related to your degree (use attached file Skill List by Program ): I am new to this position.

3 I am NOT new to this position but my degree was beneficial in obtaining or maintaining it (if marked, please fill out Student Placement Attestation form and submit along with the Employment Notification form ). I certify that the above information is true and factual. If any of the above information changes at any time, I understand that it is my responsibility to report the changes to Fairfax University of America (FXUA) and submit a new Employment Notification form . I also give FXUA permission to contact my employer to verify my employment.

4 Signature: _____ Date: _____ 3 - FOR OFFICE USE ONLY Completed by Director of Career Services: Completed by DSO: Date received: _____ by _____ Date received: _____ by _____ Placed by: Date entered into SEVIS: _____ Title CIP #_____ SOC #_____ by _____ Skills Benefit - Placement Attestation Attached ( Y / N ) Rev: 01/2020 SUPPLEMENT TO EMPLOYMENT Notification form Submit this form and supporting documents to If you have not obtained employment within 3 months of graduation. Please submit the Employment Notification form as soon as you obtain employment.

5 Contact the Career Services & Alumni Relations Department if you need any assistance or resources in identifying employment opportunities. 1 - PERSONAL INFORMATION (TO BE COMPLETED BY STUDENT) First: _____ Middle: _____ Last Name: _____ FXUA Student ID #_____ Degree and Program: _____ Graduation Date: _____ (MM/DD/YYYY) Semester: Spring / Summer I / Summer II / Fall Address: _____ City: _____ State: _____ Zip Code: _____ Phone: _____ Personal Email: _____ Status: F-1* / H-1 / H-4 / K-1 / Green Card holder / US Citizen / Other: _____ *OPT Start Date: ____/____/_____ (MM/DD/YYYY) OPT End Date.

6 ____/____/_____ (MM/DD/YYYY) 2 - REASON FOR NOT WORKING DURING REPORTING PERIOD (PLEASE CHECK ONE): Pregnancy Provide written information from institution or a family member. Death Provide written information from a family member, or friend. Health-related situations Explain below if you or an immediate family member required hospitalization, bed rest or rehabilitation at some point during the reporting period. Continued education Submit enrollment agreement or letter of acceptance as a full-time student into a new educational program that is 300 hours or longer.

7 O Check here if enrolled at FXUA. Military service Submit copy of military orders showing you, your spouse or dependent was transferred. Visa restrictions (international students) Submit a copy of visa documentation that you were restricted from working in the US. Completed FXUA ESL program. Incarceration Submit documentation that you were in jail / house arrest full time for over one month. Explanation: _____ _____ Signature: _____ Date: _____ 3 - FOR OFFICE USE ONLY Date received: _____ Director of Career Services: _____ Pregnancy, death, other health related issues (T6) ESL graduate (X6) Continuing education (U6) Incarceration (Y6) Active military service (V6) Searching for job (Z6) Visa restrictions (W6) Not working by choice (Z6)