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5 Executive Drive, Suite B1 Lafayette, IN 47905 PH: 765.807.0531 FX: 765.807.0534 www.lafayettegastro.comPATIENT INFORMATIONAL NAME: FIRST NAME: M.I.: ADDRESS: CITY: STATE: ZIP: DOB: SS#: D.L.# EMPLOYER:
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ph 765 is the form number for the Application for Employment Authorization.
Individuals seeking employment authorization in the United States are required to file ph 765.
ph 765 can be filled out online or through mail by providing personal information, immigration status, and supporting documentation.
The purpose of ph 765 is to request permission to work legally in the United States.
Information such as name, address, immigration status, I-94 number, and supporting documents must be reported on ph 765.
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