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I - 765: Application for Employment Authorization
Applicant Information Attorney Information Payment Review & Certify Confirmation
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In order to electronically process your application,
you must provide information for the items marked * below.
* I am applying for:
Permission to accept employment
Replacement (of lost employment authorization document)
Renewal of my permission to accept employment
Family Name:
  * 
Given Name:
  * 
Middle Name:
Other Names Used:
(Include Maiden Name)

Address in the United States
Number and Street:
  * 
Apt. Number:
Town or City:
  * 
State:
  * 
Zip Code:
  * 
Country of Citizenship/Nationality:
Town or City of Birth:
State/Province of Birth:
Country of Birth:
Date of Birth:
 *   / 
MM  
 / 
DD  
  
YYYY  
Sex:
 *  Male   Female  
Marital Status:
Married   Single   Widowed   Divorced  
Social Security #:
(Include all numbers you have ever used if any.)
 -   - 
 -   - 
 -   - 
A#:
OR
  
I-94#:
What is an I-94#?
In order to electronically process your application,
you must provide information for the items marked *.

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