12 (d). Failure to show proof of employment authorization during the 5-year period beginning with date for filing of the form of application and ending on the date the authorization is effective. Failure to show proof of employment authorization for a period of 20 months. (If you have more than one employer, please show proof of employment for the one you filed the form of application with.) If the denial was because you have an employment authorization revoked under 8 CFR 825.11(b), make a copy of the written denial on a separate sheet of paper, and send this to the Address listed on the Notice of Action. If you have an Employment Authorization Number (EAN) number, show the number to Employment and Support Evaluation Service (USES), Center for Employment Eligibility Assessment (CEA), U.S. Department of Labor, P.O. Box 9554, Rockville, MD 20852. Show proof of EAN on paper (one EAN for the form of application filed with the Employment Verification System (EVS), and one with the Notice of Action) and a copy of the Notice of Action. If you have a work permit issued by the Department of Homeland Security you must have a copy of your work permit and a copy of the Notice of Action and the Work Permit. Do not send this to ESSEX with your work permit as some ESSEX staff do not have access to the work permit. The work permit will be made available for you when we receive the notice of action from the Department of Homeland Security. If you do not have a work permit you should contact the Immigration Services Field Office. See 8 CFR 1924.10(a) for more information on work permit conditions. NOTE: There may be a fee for each application that has not been approved. If you have more than one employer, please send the information listed below to one of the employment eligibility offices. If you do not have a work permit, your work permit will be released to you once we receive the Notice of Action from DHS.
Address: U.S. Citizenship and Immigration Services I-765, Application For Employment Eligibility Action Block Fee Stamp Do not write in this block. Remarks A# Applicant is filing under 273a.12 Application Denied. Employment Denied / Terminated / Withdrawn / Permitted for No Reason (Circle Two) until (Date). (Date). Subject to the following conditions: APPLICATION DENIED.
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OMB No. 1615-0040 Department of Homeland Security U.S. Citizenship and Immigration Services I-765, Application For Employment Authorization Action Block Fee Stamp Do not write in this block. Remarks
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