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USCIS Form I-765

I-765 Intake Form

Application for Employment Authorization

Please complete this intake form to help us prepare your I-765 application. All information provided is confidential and protected by attorney-client privilege.

I am applying for: *

Initial permission to accept employment

Replacement of lost, stolen, or damaged employment authorization document

Renewal of my permission to accept employment

Family Name (Last Name) *

Given Name (First Name) *

Middle Name

In Care Of Name (if any)

Street Number and Name *

Apt/Ste/Flr

City or Town *

State *

ZIP Code *

Is your current mailing address the same as your physical address?

Yes

Alien Registration Number (A-Number)

USCIS Online Account Number (if any)

Social Security Number (SSN) (if known)

Sex *

Marital Status

Have you previously filed Form I-765?

Yes

Country of Citizenship or Nationality *

Second Country of Citizenship (if any)

City/Town/Village of Birth

State/Province of Birth

Country of Birth *

Date of Birth *

Enter the appropriate letter and number (e.g., (a)(8), (c)(9), (c)(10))

Eligibility Category *

Daytime Telephone Number

Mobile Telephone Number (if any)

Email Address (if any) *

Are you a Salvadoran or Guatemalan national?

Yes

I can read and understand English

Required Supporting Documents

The following documents are typically required. Your attorney will advise on specific requirements.

Initial EAD Applicants

▢Evidence of current immigration status
▢Copy of pending application receipt (I-485, I-589, etc.)
▢Birth certificate with certified English translation

Renewal EAD Applicants

▢Copy of current or most recent EAD (front and back)
▢Evidence that the basis for eligibility has not changed
▢Copy of pending application receipt (if applicable)

All Applicants

▢Completed Form I-765 (prepared by attorney)

▢2 passport-style photographs

▢Copy of government-issued photo ID

▢Copy of passport biographical page

▢Copy of I-94 Arrival/Departure Record

▢Copy of previous EAD (front and back, if renewal)

▢Copy of I-797 Approval Notice (if applicable)

▢Evidence supporting your eligibility category

⚠ All foreign language documents must be accompanied by a certified English translation.

Upload supporting documents. Formats: PDF, JPG, PNG (max. 10MB).

Recommended: Passport copy, I-94, previous EAD (front and back), I-797 approval notice, 2 passport-style photos, supporting evidence for your eligibility category.

or drag and drop here

Max file size: 10MB

You can also email documents to [email protected]

I certify, under penalty of perjury under the laws of the United States of America, that the information provided is true and correct. I authorize the release of any information from my records that U.S. Citizenship and Immigration Services may need to determine my eligibility for the immigration benefit I seek. I understand that USCIS may require me to appear for an appointment to take my biometrics (fingerprints, photograph, 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) I reviewed and provided or authorized all of the information in my application; 2) I understood all of the information contained in, and submitted with, my application; and 3) All of this information was complete, true, and correct at the time of filing. (28 U.S.C. § 1746)

I agree to the above certification *

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Someone Detained by ICE?

I-765 Intake Form

Part 1: Reason for Applying

Part 2: Information About You

Other Names Used

U.S. Mailing Address

Other Information

Place of Birth

Information About Your Last Arrival

Information About Your Eligibility Category

Part 3: Contact Information & Certification

Supporting Documents

Required Supporting Documents

Initial EAD Applicants

Renewal EAD Applicants

All Applicants

Consent and Certification