Position Cultural exchange activities Employer

Employer Information
Employer name:
Beach Mart, Inc. - Nags Head, NC
Type of business:
Retail
Job location:
Beach Mart - Store 12 - Just for the Beach - Monterey Plaza
City:
Corolla
State:
NC
Zip:
27959
Website:
Why choose us?
Beach Mart owns more than 15 retail souvenir stores (these positions primarily focus on merchandising and customer service), 2 miniature golf courses, and a gym
along the Outer Banks of North Carolina (spreading out over 160 kilometers). If you enjoy the beach, sand, ocean, fresh air and outdoors, this is the place you want to
be.
Cultural
exchange
activities
The Outer Banks
is primarily a summer
family oriented beach resort area & there is no public transportation. But even during the winter months, if you enjoy reading,
writing, painting/drawing and the outdoors, it is still a great place to come to. You will be assigned to work at one of the many stores along the 161 kilometers of shoreline
upon arrival. If you are traveling with a friend or two, make sure to let the employer know as soon as possible, so that they can do their best to house you together.
Groups of friends (3 or more) may not be the best for this job as they will surely be separated on some level.
You do not have to worry about housing with this employer. Housing is mandatory and provided by the employer at a cost of $100.00 per person, per week with a
$150.00 per person refundable deposit. Each apartment/ house is modestly furnished. However, you must bring your own sheets, towels and pillows. The beds provided
are single size & are not on frames so the mattress and box spring set on the floor.
Position
Job title:
Cashier, Stocker - Late - Store 12
Job description and required skills:
By accepting this position, you confirm that the store to which you are assigned is only a preassigned location. This location
is subject to change based on employer's needs upon your arrival. You will be trained in and required to do one or all of the
following: cashiering, stocking, pricing, folding merchandise, steam pressing designs onto t-shirts and cleaning both inside
and outside the stores (outside limited to set up/tear down of displays and picking up trash/sweeping parking lot for
cigarette butts, and so on), cleaning bathrooms. Males will have to do some heavy lifting up to 30 kilos. Please see
attachment for more information.
English level required:
advanced
Hourly wage (before taxes):
$8.00
Position ID:
27024
Employer: Beach Mart, Inc. - Nags Head, NC
Position: Cashier, Stocker - Late - Store 12
Page:
1
Position Information
Tips:
no
Bonus:
no
Estimated hours per day:
7
Number of days per week:
5
Possibility of students getting more than estimated hours:
average
If so, is overtime paid at the rate of 1.5 hourly, after 40 hours
of work per week?
yes
Earliest start date:
06/15/2015
Latest start date:
06/25/2015
Earliest end date:
09/20/2015
Latest end date:
10/25/2015
Is the employer willing to hire couples?
yes
Is the employer willing to hire group of friends?
no
Are meals included?
no
Is a drug test required?
no
Is Skype interview required?
no
Do students complete an additional application upon
arrival?
yes
Possibility to find a second job in the area
yes
Second jobs require you to contact CHI at chiwt@chinet.org or 1-800-432-4643 to receive the required form. The new potential employer will need
to complete it. Both you and the employer will need to sign and return it to CHI for approval.
You can work with a new secondary employer ONLY AFTER you have received written authorization from CHI.
Nags Head is a small beach resort area. Second jobs may be hard to find.
Additional comments regarding second job:
2ND jobs MUST be approved by CHI BEFORE you begin working and the employer MUST fill out
and sign a Job Offer.
How soon after arrival will participants begin working?
Within 3 days.
Specific instructions for arrival to employer:
Arrive Monday - Friday. The Beach Mart office is open from 9 am - 4 pm Monday - Friday only. If
you arrive outside of these hours, their office will be closed. If you arrive into Norfolk, VA after 1:00
PM, you will not have enough time to travel to Nags Head before their office closes at 4:00 PM. You
will have to take a taxi to a motel and back to Beach Mart's office; all at your expense and you will
not be able to check in until the following business day.
Go to the Beach Mart address on the job offer which is the main office for Beach Mart. Upon
arriving, you will check in with Wendy, be given paperwork to complete, be assigned and taken to
your store and/or housing.
Transportation Options:
1) James River Transportation near baggage claim #3 at the Norfolk Airport. Average cost is $200
USD. The cost is $279 USD for 1- 3 people. They have a 9 passenger van, which would be $837
USD split 9 ways = $93 per person. They may provide 10% discount. * Prices as of 08/08/2014
2) Taxi may be a little less and located outside baggage claim #4 and #5 at the Norfolk Airport.
Average cost between $150-$190 USD.
3) Private driver flat fee
Arriving into Hampton, VA Greyhound Station only:
$140 USD for up to 3 people, you need to email/ call Steven Moody at stevenstixx@gmail.com/
1-757-450-3108 at least 10 days in advance to see if he is available to pick you? If he is, you will
need to confirm your arrival information and he will meet you at the Greyhound station. If you chose
Employer: Beach Mart, Inc. - Nags Head, NC
Position: Cashier, Stocker - Late - Store 12
Page:
2
this option and cancel after you arrive, there is a $25 cancellation fee.
If you have 7 or more people, please contact Teresa Ottofaro directly at chiteresa@chinet.org or
1-866-432-0871.
Arriving in Norfolk, VA Airport (ORF) only:
$130 USD for one person, $140 USD for 2 and $150 USD for 3, you will need to call Dallas Hawks
1-757-450-3108 at least 10 days in advance to see if he is available to pick you? If he is, you will
need to confirm your arrival information and he will meet you at baggage claim. If you chose this
option and cancel after you arrive, there is a $25 cancellation fee.
Is training required?
yes
Conditions of training:
Training is paid at the same wage and the length of training depends on how quickly you learn and
are able to perform required duties at or above a satisfactory level.***Possibility of overtime
depends on your work performance and needs of the business.
Is there possibility to change positions?
no
Are students required to wear a uniform?
yes
Does employer provide uniform?
yes
Cost of uniform:
$3 - $5 per shirt
Is uniform refundable?
no
Employer: Beach Mart, Inc. - Nags Head, NC
Position: Cashier, Stocker - Late - Store 12
Page:
3
Do students need to purchase specific clothes or footwear?
yes
If so, details for clothing:
Grooming requirements: no facial piercings except earrings, no bold or unnatural hair colors.
Uniform: employer will provide t-shirt you are free to wear shorts, jeans, pants, or skirts (No short
shorts or mini skirts, must be conservative length). You may wear whatever type of flat shoes you
like (no high heels).
Additional information:
Students traveling alone or traveling with one or 2 friends is okay for this job. However, if you are traveling in a large group, it is very likely that you will be split up and
assigned to live in different houses and work at stores that are anywhere from 1-85 miles apart. So please - no large groups unless you are okay with being separated
from your friends. There is no promise that any of you will ever have the same days off or will work the same hours. A couple of the stores are in remote areas of the
islands. It is very beautiful and peaceful, but it is remote. You will be on or very close to the Atlantic Ocean.
Housing Information
Housing name:
Beach Mart - Carolina Court M for Stores 4,12,13,15 & 19
Housing address:
817M Caroline Court
City:
Corolla, NC 27927
Phone:
252-453-8294
Fax:
Contact:
Wendy Ray
Email:
beachmartinc@gmail.com
Website:
Housing assisted by:
Employer
Is student required to sign a separate housing contract?
yes
If so, contract details:
Students are required to stay in company-provided housing (This location is behind Souvenir City
and near Store 11). Students will be assigned housing after their store location is assigned.
Students are asked to read & sign a lease for the house or apartment where they will be living. This
is for the protection of the student & employer. The type of housing may be a house, condo or
apartment depending on location.
Type of housing:
Apartment
Number of people to a room:
2-4
Bedrooms:
2-3
Bath:
1-2
Estimated cost of housing per week:
$100.00 per person
Is housing cost deducted from paycheck?
yes
Is housing deposit required?
yes
Deposit amount:
$120 per person
Housing deposit due date:
Arrival
Instructions for deposit payment:
$120.00 Deposit must be paid in cash upon arrival prior to checking into the house. You will be
given a receipt that you will need to keep. As long as there are no damages to your housing and you
have fulfilled your work and housing commitment and returned your key, you will be refunded in
cash by your manager upon inspection of the property the day you leave. You will be charged $20
for each lost or stolen key or any key that is not returned .
Employer: Beach Mart, Inc. - Nags Head, NC
Position: Cashier, Stocker - Late - Store 12
Page:
4
Is housing deposit refundable?
yes
Conditions for deposit refund:
Student must keep housing in good condition by cleaning it and not having any damage. If there is
any damage when you first arrive, make sure to write it down & notify employer ASAP. Also, send a
copy of the damage to chiteresa@chinet.org. You must do this within the first 2 days of arriving to
the house. Everyone in each unit is responsible for damage.
Utilities included:
Employer: Beach Mart, Inc. - Nags Head, NC
yes
Position: Cashier, Stocker - Late - Store 12
Page:
5
Telephone (local calls only),cable, water, electric & gas are included in the student's rental. You
If so, utilities details:
must provide your own sheets, towels & pillows. The beds are all twin size & it is a mattress on the
floor, not on a bed frame. If you would like a frame, you will have to purchase that yourself. You may
choose to bring your own sheets/towels/pillows from home, or wait & buy them once you arrive at
Walmart or Kmart. You can pick them up for about $20-25 dollars total.
Utilities estimated cost per month:
Included
Is the housing mandatory?
yes
Can students find alternative housing during their stay?
no
Method of transportation from housing to work site:
Walking
Transportation details:
Within .25 mile of all stores
Additional housing features:
This housing is mandatory. Job and housing go hand in hand. You cannot find alternative housing.
You must provide your own sheets, towels & pillows. The beds are all twin size & it is a mattress on
the floor, not on a bed frame. If you would like a frame, you will have to purchase that yourself. You
may choose to bring your own sheets/towels/pillows from home, or wait & buy them once you arrive
at Walmart or Kmart. You can pick them up for about $20-25 dollars total.
Location of work site best described as:
Ocean
Location details:
This is a summer resort area, if you enjoy the sun, water, beach, reading, drawing, quiet time with
friends, this is the place for you. If you want clubs, pubs, and a wild night life, this is not the place for
you. There is no public transportation, only taxi service so be prepared to either do a lot of walking
or to purchase a bicycle.
Average daily temperature:
80 F & up; very humid
Community or regional website:
www.outerbanks.com
Nearest cities:
Elizabeth City 18,683
Distance to nearest cities:
61 miles
What to wear:
Swimsuit, shorts, tank tops, light jacket, jeans, t-shirts.
Available public transportation:
Taxis only
Public transportation access:
Taxi only
Accessible amenities (by walking or public transportation):
Food market:
yes
Shopping mall:
yes
Post office:
yes
Bank:
yes
Movie theater:
yes
Restaurants:
yes
Fitness center:
no
Laundry:
yes
Internet café:
yes
Public library:
no
Comments:
Employer: Beach Mart, Inc. - Nags Head, NC
Position: Cashier, Stocker - Late - Store 12
Page:
6
Spring students may be the housing when you arrive. They will remain there until the end of their program. Arrive Monday - Friday. The Beach Mart office is open from 9
am - 4 pm Monday - Friday only. If you arrive outside of these hours, their office will be closed. If you arrive into Norfolk, VA after 1:00 PM, you will not have enough time
to travel to Nags Head before their office closes at 4:00 PM. You will have to take a taxi to a motel and back to Beach Mart's office; all at your expense and you will not
be able to check in until the following business day.
Go to the Beach Mart address on the job offer which is the main office for Beach Mart. Upon arriving, you will check in with Wendy, be given paperwork to complete, be
assigned and taken to your store and/or housing.
Transportation Options:
1) James River Transportation near baggage claim #3 at the Norfolk Airport. Average cost is $200 USD. The cost is $279 USD for 1- 3 people. They have a 9
passenger van, which would be $837 USD split 9 ways = $93 per person. They may provide 10% discount. * Prices as of 08/08/2014
2) Taxi may be a little less and located outside baggage claim #4 and #5 at the Norfolk Airport. Average cost between $150-$190 USD.
3) Private driver flat fee
Employer: Beach Mart, Inc. - Nags Head, NC
Position: Cashier, Stocker - Late - Store 12
Page:
7
Suggested Travel Information
Nearest international airport:
Norfolk International Airport (ORF)
Nearest airport:
Norfolk International Airport (ORF)
Transportation from airport to employer and / or housing:
www.jamesrivertrans.com/norfolk
Nearest bus station (to the airport):
Greyhound
Bus information (web site):
www.greyhound.com
Nearest train information (to the airport):
Amtrak
Train information (web site):
www.amtrak.com
If participant arrives after hours suggested, overnight
accomodation:
Hotel in Norfolk, VA
Cost per night:
$45 - $60
Transportation to overnight accomodation:
Taxi
Transportations cost:
Varies
Specific instructions:
Arrive Monday - Friday. The Beach Mart office is open from 9 am - 4 pm Monday - Friday only. If
you arrive outside of these hours, their office will be closed. If you arrive into Norfolk, VA after 1:00
PM, you will not have enough time to travel to Nags Head before their office closes at 4:00 PM. You
will have to take a taxi to a motel and back to Beach Mart's office; all at your expense and you will
not be able to check in until the following business day.
Go to the Beach Mart address on the job offer which is the main office for Beach Mart. Upon
arriving, you will check in with Wendy, be given paperwork to complete, be assigned and taken to
your store and/or housing.
Transportation Options:
1) James River Transportation near baggage claim #3 at the Norfolk Airport. Average cost is $200
USD. The cost is $279 USD for 1- 3 people. They have a 9 passenger van, which would be $837
USD split 9 ways = $93 per person. They may provide 10% discount. * Prices as of 08/08/2014
2) Taxi may be a little less and located outside baggage claim #4 and #5 at the Norfolk Airport.
Average cost between $150-$190 USD.
3) Private driver flat fee
Arriving into Hampton, VA Greyhound Station only:
$140 USD for up to 3 people, you need to email/ call Steven Moody at stevenstixx@gmail.com/
1-757-450-3108 at least 10 days in advance to see if he is available to pick you? If he is, you will
need to confirm your arrival information and he will meet you at the Greyhound station. If you chose
this option and cancel after you arrive, there is a $25 cancellation fee.
If you have 7 or more people, please contact Teresa Ottofaro directly at chiteresa@chinet.org or
1-866-432-0871.
Arriving in Norfolk, VA Airport (ORF) only:
$130 USD for one person, $140 USD for 2 and $150 USD for 3, you will need to call Dallas Hawks
1-757-450-3108 at least 10 days in advance to see if he is available to pick you? If he is, you will
need to confirm your arrival information and he will meet you at baggage claim. If you chose this
option and cancel after you arrive, there is a $25 cancellation fee.
Social Security Information
Does the company require students to have Social
Security number before arriving to the work place?
no
Does the company provide Social Security application
yes
assistance?
Employer: Beach Mart, Inc. - Nags Head, NC
Position: Cashier, Stocker - Late - Store 12
Page:
8
Employer arranges for transportation (for a fee) to nearest office which is over an hour away. But
If so, details:
we coordinate with all our locations so the cost is at a minimum to the students.
www.ssa.gov/online/ss-5.pdf
Please print this form and bring it with you to the USA.
Where is the closest Social Security office?
1865 WestCity Dr.,Elizabeth City,NC
How far is the Social Security office from the work place?
1 Hour
Specific instructions:
Make sure to read your student handbook and to take all of your documents with you. If you fail to
take all of the required documents with you, you will have to travel back to social security on another
day at your own expense.
Employer: Beach Mart, Inc. - Nags Head, NC
Position: Cashier, Stocker - Late - Store 12
Page:
9
Cashier-Stockers $7.50/hour
Work hard, play hard…..The Outer Banks, North Carolina…………
The Outer Bank beaches are the ultimate
playground for fun! You'll find miles of
pristine shoreline, rolling dunes, and
maybe even dolphins playing in the
glistening water. Spend your days off
surfing, scuba diving, building sandcastles
or just basking in the sun…..
Visit The Wright brothers' National
Memorial in Kill Devil Hills where their first
controlled, powered airplane flights
occurred on December 17, 1903.
Watch the sunrise, ride
your bike or fish off of
along Jennette’s Pier. Or,
go on a jeep tour to see
the wild Colonial Spanish
Mustangs.
Bikes are the way to go along
the Outer Banks, make sure to
find a cheap one as soon as
you arrive!
BEACH MART JOB DUTIES
By accepting this position, you confirm that the store to which you are assigned is only a pre-assigned
location. This location is subject to change based on employers needs upon your arrival. Your exact
location is not confirmed until you arrive and complete your paperwork at that time you will be given
your confirmed housing and store location and provided free transportation to your assigned store. Now
on occasion if you arrive near close of business or if you are assigned to one of the stores and housing
located in a remote area there is a chance that you may be asked to stay for 1-3 days in a transition
house located 3 blocks from the main office. It is a very nice, large house. Since they are providing you
with free transportation from the main office to your assigned housing for the more remote stores trips
are not made daily to those locations so please be flexible.
You will be trained in and required to do one or all of the following: cashiering, stocking, pricing, folding
merchandise, steam pressing designs onto t-shirts and cleaning both inside and outside the stores
(outside limited to set up/tear down of displays and picking up trash/sweeping parking lot for cigarette
butts, and so on), cleaning bathrooms. Males also will be lifting and moving large boxes so you should
have a medium to large build and be able to carry upwards of 23 kilos you may also on occasion be
required to climb a ladder inside of the store to reset clothing displays on the walls. Most boxes range in
sizes from 12"x24" to 36"x36". You will have to be able to lift and carry these boxes without assistance.
Males may also most likely have additional duties transporting stock from offsite storage to the various
stores (this means you would ride as a passenger in a van with a supervisor) go over to the storage area
load merchandise into the van and then take it and drop it off at your store as well as other stores.
Hello!
Welcome to the U.S. State Departments Work and Travel USA Cultural Exchange Program. Cultural Homestay International
(CHI) will be your sponsor. My name is Jill Davis and I am your Program Coordinator. I am available to assist you with any
questions you might have during your program. My goal is for us to maintain good communication and ask you to please
check your email frequently. Here are a few very important things to remember.
As soon as you purchase your plane tickets log onto www.sevis.org (Use your last name and number found on your DS2019
form), enter your complete travel arrangements as soon as you make your flight reservations. You only need to input the
flight information to your FINAL DESTINATION. Be sure and include how you are getting to your employers from the airport
and the date & time of arrival at your employer. YOU MUST ALSO NOTIFY YOUR EMPLOYER AT LEAST TWO WEEKS IN
ADVANCE OF YOUR ARRIVAL!
When you fly make sure to keep the following important documents with you at all times while traveling:
•
Passport
•
J-1 visa
•
DS-2019
•
CHI Student Handbook
•
Arrival Instructions Letter •
Sponsorship Letter from CHI
•
Job Offer
When you travel, you should keep all your documents in your carry-on bag and with you at all times. Please make copies to
leave with your family. Make sure you do not carry large amounts of cash with you. You do have to have access to at least
$1000 when you arrive. This does not mean to bring it all in cash, it can be a combination of travelers checks, bank card,
some cash, etc.
After you arrive in the USA Please login to SEVIS again to show proof of your arrival. The US State Department requires you
to do this within 3 days of entering the US. You are required to input your 1-94 number and housing address of where you
will be living in the US. The US Government must know where you live at all times.
Please remember to use your home address in your home country (NOT your University address) when filling out all
paperwork with your new employer. This is very important and ensures that your employers can forward any
important employment related documents to you by mail after you return home. DO NOT use your U.S. housing
address as documents will not be forwarded to you. When your program is complete and you are preparing to return
home, it is very important that you give your employer 2 self-addressed stamped envelopes.
You must be VALIDATED in SEVIS and be in the US for at least 10 business days BEFORE going to apply for your Social
Security card. If you do not, it will delay or prevent you from receiving you SS number.
To check to see if you are validated, go back into the SEVIS system 3 days after you validated yourself. An "S" in the status
field indicates your successful validation. If you require support, please contact CHI at chiwt@chinet.org or calling CHI at 1800-432-4643.
Second Jobs – You are not allowed to work or start training at a 2nd job without CHI permission. Contact me for details.
Monthly Reports You are required to complete a online questionnaire each month of your program. An email will be sent to
you monthly, requesting you to log onto SEVIS to complete the questionnaire. Be sure and check your email frequently. Your
program will be at risk if you do not complete the required monthly questionnaire.
Your employer would like to remember you. We encourage that you bring a small gift from your home country, such as: a key
chain, picture postcard, magnet, chocolates, etc. This will certainly bring a smile to their face and it is a nice gesture they will
not forget!
I would like to wish you a wonderful cultural exchange program filled with unforgettable memories to cherish. Please be sure
to take plenty of pictures and keep a journal. We are very excited about your arrival in the United States of America and I
look forward to working with you to make this a truly life changing and meaningful experience!
Warm Regards,
Jill Davis - chijilld@gmail.com
Arrive Monday - Friday. The Beach Mart office is open from 9 am - 4 pm Monday - Friday only. If you
arrive outside of these hours, their office will be closed. If you arrive into Norfolk, VA after 1:00 PM, you
will not have enough time to travel to Nags Head before their office closes at 4:00 PM. You will have to
take a taxi to a motel and back to Beach Mart's office; all at your expense and you will not be able to
check in until the following business day.
Go to the Beach Mart address on the job offer which is the main office for Beach Mart. Upon arriving,
you will check in with Wendy, be given paperwork to complete, be assigned and taken to your store
and/or housing.
Transportation Options:
1) James River Transportation near baggage claim #3 at the Norfolk Airport. Average cost is $200
USD. The cost is $279 USD for 1- 3 people. They have a 9 passenger van, which would be $837
USD split 9 ways = $93 per person. They may provide 10% discount. * Prices as of 08/08/2014
2) Taxi may be a little less and located outside baggage claim #4 and #5 at the Norfolk Airport.
Average cost between $150-$190 USD.
3) Private driver flat fee
Arriving into Hampton, VA Greyhound Station only:
$140 USD for up to 3 people, you need to email/ call Steven Moody at stevenstixx@gmail.com/
1-757-450-3108 at least 10 days in advance to see if he is available to pick you? If he is, you will
need to confirm your arrival information and he will meet you at the Greyhound station. If you
chose this option and cancel after you arrive, there is a $25 cancellation fee.
If you have 7 or more people, please contact Teresa Ottofaro directly at chiteresa@chinet.org or
1-866-432-0871.
Arriving in Norfolk, VA Airport (ORF) only:
$130 USD for one person, $140 USD for 2 and $150 USD for 3, you will need to call Dallas Hawks
1-757-450-3108 at least 10 days in advance to see if he is available to pick you? If he is, you will
need to confirm your arrival information and he will meet you at baggage claim. If you chose
this option and cancel after you arrive, there is a $25 cancellation fee.
SOCIAL SECURITY ADMINISTRATION
Application for a Social Security Card
Applying for a Social Security Card is free!
USE THIS APPLICATION TO:
●
●
●
Apply for an original Social Security card
Apply for a replacement Social Security card
Change or correct information on your Social Security number record
IMPORTANT: You MUST provide a properly completed application and the required evidence before we
can process your application. We can only accept original documents or documents certified by the
custodian of the original record. Notarized copies or photocopies which have not been certified by the
custodian of the record are not acceptable. We will return any documents submitted with your application.
For assistance call us at 1-800-772-1213 or visit our website at www.socialsecurity.gov.
Original Social Security Card
To apply for an original card, you must provide at least two documents to prove age, identity, and U.S.
citizenship or current lawful, work-authorized immigration status. If you are not a U.S. citizen and do not
have DHS work authorization, you must prove that you have a valid non-work reason for requesting a
card. See page 2 for an explanation of acceptable documents.
NOTE: If you are age 12 or older and have never received a Social Security number, you must apply in
person.
Replacement Social Security Card
To apply for a replacement card, you must provide one document to prove your identity. If you were born
outside the U.S., you must also provide documents to prove your U.S. citizenship or current, lawful,
work-authorized status. See page 2 for an explanation of acceptable documents.
Changing Information on Your Social Security Record
To change the information on your Social Security number record (i.e., a name or citizenship change, or
corrected date of birth) you must provide documents to prove your identity, support the requested change,
and establish the reason for the change. For example, you may provide a birth certificate to show your
correct date of birth. A document supporting a name change must be recent and identify you by both your
old and new names. If the name change event occurred over two years ago or if the name change
document does not have enough information to prove your identity, you must also provide documents to
prove your identity in your prior name and/or in some cases your new legal name. If you were born outside
the U.S. you must provide a document to prove your U.S. citizenship or current lawful, work-authorized
status. See page 2 for an explanation of acceptable documents.
LIMITS ON REPLACEMENT SOCIAL SECURITY CARDS
Public Law 108-458 limits the number of replacement Social Security cards you may receive to 3 per
calendar year and 10 in a lifetime. Cards issued to reflect changes to your legal name or changes to a work
authorization legend do not count toward these limits. We may also grant exceptions to these limits if you
provide evidence from an official source to establish that a Social Security card is required.
IF YOU HAVE ANY QUESTIONS
If you have any questions about this form or about the evidence documents you must provide, please visit
our website at www.socialsecurity.gov for additional information as well as locations of our offices and
Social Security Card Centers. You may also call Social Security at 1-800-772-1213. You can also find
your nearest office or Card Center in your local phone book.
Form SS-5 (08-2011) ef (08-2011) Destroy Prior Editions
Page 1
EVIDENCE DOCUMENTS
The following lists are examples of the types of documents you must provide with your application and are not all
inclusive. Call us at 1-800-772-1213 if you cannot provide these documents.
IMPORTANT : If you are completing this application on behalf of someone else, you must provide evidence that
shows your authority to sign the application as well as documents to prove your identity and the identity of the
person for whom you are filing the application. We can only accept original documents or documents certified by
the custodian of the original record. Notarized copies or photocopies which have not been certified by the
custodian of the record are not acceptable.
Evidence of Age
In general, you must provide your birth certificate. In some situations, we may accept another document that
shows your age. Some of the other documents we may accept are:
● U.S. hospital record of your birth (created at the time of birth)
● Religious record established before age five showing your age or date of birth
● Passport
● Final Adoption Decree (the adoption decree must show that the birth information was taken from the original
birth certificate)
Evidence of Identity
You must provide current, unexpired evidence of identity in your legal name. Your legal name will be shown on
the Social Security card. Generally, we prefer to see documents issued in the U.S. Documents you submit to
establish identity must show your legal name AND provide biographical information (your date of birth, age, or
parents' names) and/or physical information (photograph, or physical description - height, eye and hair color,
etc.). If you send a photo identity document but do not appear in person, the document must show your
biographical information (e.g., your date of birth, age, or parents' names). Generally, documents without an
expiration date should have been issued within the past two years for adults and within the past four years for
children.
As proof of your identity, you must provide a:
● U.S. driver's license; or
● U.S. State-issued non-driver identity card; or
● U.S. passport
If you do not have one of the documents above or cannot get a replacement within 10 work days, we may accept
other documents that show your legal name and biographical information, such as a U.S. military identity card,
Certificate of Naturalization, employee identity card, certified copy of medical record (clinic, doctor or hospital),
health insurance card, Medicaid card, or school identity card/record. For young children, we may accept medical
records (clinic, doctor, or hospital) maintained by the medical provider. We may also accept a final adoption
decree, or a school identity card, or other school record maintained by the school.
If you are not a U.S. citizen, we must see your current U.S. immigration document(s) and your foreign passport
with biographical information or photograph.
WE CANNOT ACCEPT A BIRTH CERTIFICATE, HOSPITAL SOUVENIR BIRTH CERTIFICATE, SOCIAL
SECURITY CARD STUB OR A SOCIAL SECURITY RECORD as evidence of identity.
Evidence of U.S. Citizenship
In general, you must provide your U.S. birth certificate or U.S. Passport. Other documents you may provide are a
Consular Report of Birth, Certificate of Citizenship, or Certificate of Naturalization.
Evidence of Immigration Status
You must provide a current unexpired document issued to you by the Department of Homeland Security (DHS)
showing your immigration status, such as Form I-551, I-94, or I-766. If you are an international student or
exchange visitor, you may need to provide additional documents, such as Form I-20, DS-2019, or a letter
authorizing employment from your school and employer (F-1) or sponsor (J-1). We CANNOT accept a receipt
showing you applied for the document. If you are not authorized to work in the U.S., we can issue you a Social
Security card only if you need the number for a valid non-work reason. Your card will be marked to show you
cannot work and if you do work, we will notify DHS. See page 3, item 5 for more information.
Form SS-5 (08-2011) ef (08-2011)
Page 2
HOW TO COMPLETE THIS APPLICATION
Complete and sign this application LEGIBLY using ONLY black or blue ink on the attached or
downloaded form using only 8 ½” x 11” (or A4 8.25” x 11.7”) paper.
GENERAL: Items on the form are self-explanatory or are discussed below. The numbers match the
numbered items on the form. If you are completing this form for someone else, please complete the
items as they apply to that person.
4. Show the month, day, and full (4 digit) year of birth; for example, “1998” for year of birth.
5. If you check “Legal Alien Not Allowed to Work” or “Other,” you must provide a document from a
U.S. Federal, State, or local government agency that explains why you need a Social Security number
and that you meet all the requirements for the government benefit. NOTE: Most agencies do not require
that you have a Social Security number. Contact us to see if your reason qualifies for a Social Security
number.
6., 7. Providing race and ethnicity information is voluntary and is requested for informational and
statistical purposes only. Your choice whether to answer or not does not affect decisions we make on
your application. If you do provide this information, we will treat it very carefully.
9.B., 10.B. If you are applying for an original Social Security card for a child under age 18, you MUST
show the parents' Social Security numbers unless the parent was never assigned a Social Security
number. If the number is not known and you cannot obtain it, check the “unknown” box.
13. If the date of birth you show in item 4 is different from the date of birth currently shown on your
Social Security record, show the date of birth currently shown on your record in item 13 and provide
evidence to support the date of birth shown in item 4.
16. Show an address where you can receive your card 7 to 14 days from now.
17. WHO CAN SIGN THE APPLICATION? If you are age 18 or older and are physically and mentally
capable of reading and completing the application, you must sign in item 17. If you are under age 18,
you may either sign yourself, or a parent or legal guardian may sign for you. If you are over age 18 and
cannot sign on your own behalf, a legal guardian, parent, or close relative may generally sign for you. If
you cannot sign your name, you should sign with an "X” mark and have two people sign as witnesses in
the space beside the mark. Please do not alter your signature by including additional information on the
signature line as this may invalidate your application. Call us if you have questions about who may sign
your application.
HOW TO SUBMIT THIS APPLICATION
In most cases, you can take or mail this signed application with your documents to any Social Security
office. Any documents you mail to us will be returned to you. Go to
https://secure.ssa.gov/apps6z/FOLO/fo001.jsp to find the Social Security office or Social Security Card
Center that serves your area.
Form SS-5 (08-2011) ef (08-2011)
Page 3
PROTECT YOUR SOCIAL SECURITY NUMBER AND CARD
Protect your SSN card and number from loss and identity theft. DO NOT carry your SSN card with you.
Keep it in a secure location and only take it with you when you must show the card; e.g., to obtain a new
job, open a new bank account, or to obtain benefits from certain U.S. agencies. Use caution in giving
out your Social Security number to others, particularly during phone, mail, email and Internet requests
you did not initiate.
PRIVACY ACT STATEMENT
Collection and Use of Personal Information
Sections 205(c) and 702 of the Social Security Act, as amended, authorize us to collect this
information. The information you provide will be used to assign you a Social Security number and
issue a Social Security card.
The information you furnish on this form is voluntary. However, failure to provide the requested
information may prevent us from issuing you a Social Security number and card.
We rarely use the information you supply for any purpose other than for issuing a Social Security
number and card. However, we may use it for the administration and integrity of Social Security
programs. We may also disclose information to another person or to another agency in accordance
with approved routine uses, which include but are not limited to the following:
1. To enable a third party or an agency to assist Social Security in establishing rights to
Social Security benefits and/or coverage;
2. To comply with Federal laws requiring the release of information from Social Security
records (e.g., to the Government Accountability Office and Department of Veterans'
Affairs);
3. To make determinations for eligibility in similar health and income maintenance
programs at the Federal, State, and local level; and
4. To facilitate statistical research, audit or investigative activities necessary to assure the
integrity of Social Security programs.
We may also use the information you provide in computer matching programs. Matching programs
compare our records with records kept by other Federal, State, or local government agencies.
Information from these matching programs can be used to establish or verify a person's eligibility
for Federally-funded or administered benefit programs and for repayment of payments or
delinquent debts under these programs.
Complete lists of routine uses for this information are available in System of Records Notice
60-0058 (Master Files of Social Security Number (SSN) Holders and SSN Applications). The
Notice, additional information regarding this form, and information regarding our systems and
programs, are available on-line at www.socialsecurity.gov or at any local Social Security office.
This information collection meets the requirements of 44 U.S.C. §3507, as amended by Section 2 of the
Paperwork Reduction Act of 1995 . You do not need to answer these questions unless we display a
valid Office of Management and Budget control number. We estimate that it will take about 8.5 to 9.5
minutes to read the instructions, gather the facts, and answer the questions. You may send comments
on our time estimate to: SSA, 6401 Security Blvd., Baltimore, MD 21235-6401. Send only comments
relating to our time estimate to this address, not the completed form.
Form SS-5 (08-2011) ef (08-2011)
Page 4
SOCIAL SECURITY ADMINISTRATION
Application for a Social Security Card
NAME
First
Full Middle Name
Last
FULL NAME AT BIRTH
IF OTHER THAN ABOVE
First
Full Middle Name
Last
TO BE SHOWN ON CARD
1
Form Approved
OMB No. 0960-0066
OTHER NAMES USED
2
Social Security number previously assigned to the person
listed in item 1
3
PLACE
OF BIRTH
5
(Do Not Abbreviate)
Office
Use
Only
City
( Check One )
ETHNICITY
8
SEX
11
12
Yes
7
No
RACE
Select One or More
(Your Response is Voluntary)
Male
DATE
OF
BIRTH
4
FCI
Legal Alien
Allowed To
Work
U.S. Citizen
Are You Hispanic or Latino?
(Your Response is Voluntary)
10
State or Foreign Country
CITIZENSHIP
6
9
-
MM/DD/YYYY
Other (See
Instructions On
Page 3)
Legal Alien Not Allowed
To Work(See
Instructions On Page 3)
Native Hawaiian
American Indian
Alaska Native
Other Pacific
Islander
Black/African
American
White
Asian
Female
First
A. PARENT/ MOTHER'S
NAME AT HER BIRTH
B. PARENT/ MOTHER'S SOCIAL
SECURITY NUMBER (See instructions for 9 B on Page 3)
First
A. PARENT/ FATHER'S
NAME
B. PARENT/ FATHER'S SOCIAL SECURITY
NUMBER (See instructions for 10B on Page 3)
Full Middle Name
-
Last
-
Full Middle Name
-
Unknown
Last
-
Unknown
Has the person listed in item 1 or anyone acting on his/her behalf ever filed for or received a Social Security number
card before?
Yes (If "yes" answer questions 12-13)
No
Don't Know (If "don't know," skip to question 14.)
Name shown on the most recent Social
Security card issued for the person
listed in item 1
First
Full Middle Name
any different date of birth if used on an
13 Enter
earlier application for a card
TODAY'S
14 DATE
MM/DD/YYYY
DAYTIME PHONE
15 NUMBER
MM/DD/YYYY
Last
Area Code
Number
Street Address, Apt. No., PO Box, Rural Route No.
16 MAILING ADDRESS
City
(Do Not Abbreviate)
State/Foreign Country
ZIP Code
I declare under penalty of perjury that I have examined all the information on this form, and on any accompanying statements or forms,
and it is true and correct to the best to my knowledge.
17 YOUR SIGNATURE
18
YOUR RELATIONSHIP TO THE PERSON IN ITEM 1 IS:
Natural Or
Adoptive Parent
Self
Legal Guardian
Other
Specify
DO NOT WRITE BELOW THIS LINE (FOR SSA USE ONLY )
NPN
PBC
DOC
EVI
EVA
EVC
NTI
CAN
PRA
NWR
ITV
DNR
UNIT
SIGNATURE AND TITLE OF EMPLOYEE(S) REVIEWING
EVIDENCE AND/OR CONDUCTING INTERVIEW
EVIDENCE SUBMITTED
DATE
DCL
Form SS-5 (08-2011) ef (08-2011)
Destroy Prior Editions
Page 5
DATE