Please fax this form to (415) 339-2744
Participant 2-Week Notice Form
For Regular Placement, Regular Job Fair Hires or Independents
(“Lock In” Participants are not eligible for 2 weeks notice)
To: CCUSA-Work Experience USA
My name is _______________________________, my CCUSA ID number is ______________.
This letter is to inform you that today, _____/____/______, I am giving my employer two weeks
notice. ___/____/_____ will be my last day of work. My first day of work was ____/____/______.
My employer’s company name is______________________ and their phone # is (_____)_________.
I understand the following conditions if I decide to end my employment:
1. CCUSA requires that I submit this 2 Week Notice Form.
2. CCUSA requires that I must work for my employer for 2 weeks before giving 2 weeks notice, unless my
employer releases me below or CCUSA decides there are reasons to excuse me from this requirement.
3. I must discuss the entire situation with CCUSA prior to giving 2 weeks notice.
4. I agree to call the CCUSA office at 1-888-449-3872 during business hours (M-F 7:00am to 4:30pm PST) on
my last day of work.
5. I have ticked my chosen option (tick one only):
a. I chose to find a new job. I must revalidate my visa in SEVIS (by visiting http://footprints.ccusa.com),
enter my new physical address and submit an Independent Job Offer within 10 days of the departure
date on this form.
b. I chose to travel around the US but not work. I understand that my J1 visa will be ended and my 30-
day grace period starts. I understand that I am no longer on the J1 visa and am not required to report
to SEVIS.
c. I chose to return home. I understand that my J1 visa will be ended.
6. If I do not follow these procedures, I understand that my visa will be terminated. This results in a negative
record in the SEVIS system and requires that I leave the US immediately.
If my employer decides to waive the 2-week notice and agrees that I may leave immediately, he/she will indicate so here.
I, this participant’s employer, agree to waive the 2-week notice for this participant, and in doing so I
understand that I must waive it for all other CCUSA staff.
I, this participant’s employer, do not waive the 2-week notice for this participant.
Employer (please tick the appropriate box above) Work Experience USA Participant
____________________________
(sign name)
____________________________
(print name)
____________________________
(sign name)
____________________________
(print name)
