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Applicant Information Page 2 - I-765 - BCIS

I - 765: Application for Employment Authorization
Applicant Information Attorney Information Payment Review & Certify Confirmation
You have chosen the attorney version of the I-765 form. To modify this choice, please select the Back button on your browser. Otherwise, please complete the form.

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 *.
I - 765: Application for Employment Authorization
Applicant Information Attorney Information Payment Review & Certify Confirmation
BCIS Receipt Number:
MSC0000000000
Date of Submission:
05/29/2003
ASC Fingerprint Code:
2
First Name:
John or Jane
Middle Name:
Family Name:
DOE
Filing Fee:
$120.00
Total Amount Paid:
$120.00

Next Steps.

Thank you for filing your BCIS benefit application electronically. Your application will be electronically transmitted to the appropriate BCIS location for processing. You will receive an official Receipt Notice (I-797) within 7-10 days by standard mail with the same Receipt Number found at the top of this page

You must phone the BCIS National Customer Service Center at 1-800-375-5283 [TTY 1-800-767-1833] to schedule an appointment with your local Application Support Center. The Application Support Center will collect a digital photograph, signature, and fingerprints from you at your appointment. YOUR APPLICATION CANNOT BE PROCESSED UNTIL YOU HAVE APPEARED FOR YOUR APPOINTMENT AT THE APPLICATION SUPPORT CENTER.

If you are required to mail supporting documentation, you must attach this Confirmation Receipt as a cover page for the supporting documentation that you are submitting. DO NOT send photos or copies of identification unless requested to do so. Instructions are provided below to assist you in determining where your supporting documentation should be mailed.

REMEMBER TO INCLUDE A COPY OF THIS PAGE SO WE MAY PROPERLY MATCH THE DOCUMENTS TO YOUR APPLICATION.

Mailing address for supporting documentation:

BCIS Service Center (MO)
Attn: E-Filed I-765
P.O. BOX 648000
LEE'S SUMMIT, MO 64064



Where your application is electronically sent:  Your application will be electronically transmitted to the appropriate BCIS Field Office for processing.


For assistance or questions regarding your application you may call our National Customer Service Center at 1-800-375-5283 [TTY 1-800-767-1833]. For status of your application you can access the BCIS web site at BCIS.
Preview the filled application in PDF format

Back to BCIS E-Filing Home



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