TN Visa Employee Request

Please read carefully:

  • For employers only. Looking for job applications? Click here.
  • All questions must be answered.
  • All fields are required to process your request.
  • Incomplete applications may delay processing.
  • If a question does not apply, write “N/A.”
  • Confidentiality: Agri-Placement Services, Inc. (APS) treats all information as strictly confidential and uses it only to provide services.
  • If you need a printable version, download this PDF, complete it, and send it to contact@agriplacement.com using Request for Agricultural Employees as the subject line.
1

Business and Employer Information 

2

Job Specifications

3

References

4

TN Visa Agency and Indemnity Agreement

1

Business and Employer Information 

Business Information

APS Representative's Name *
Have You Previously Participated in the TN Visa Program? *
Complete Company Name *
Doing Business As/Trade Name (If different from above, otherwise enter “N/A”) *
Taxpayer FEIN *
Type of Entity *
Mailing Address *
Street Address *
Worksite Address *
Fax Number(s) (If not applicable, enter “N/A”) *
Website Address *
Worker's Compensation Insurance Carrier Name *
WC Policy # *
WC Expiration Date *
WC Contact Person *
WC Contact Phone # *

Company Owner & Point of Contact Information

Name of Company Owner or President *
Main Phone # *
Cell Phone # *
E-mail Address *
Person Responsible for the TN Visa Application Process *
Title *
Main Phone # *
Cell Phone # *
E-mail Address *
1

Business and Employer Information 

2

Job Specifications

3

References

4

TN Visa Agency and Indemnity Agreement

  • Please provide separate information for each job category, occupation, or profession.
  • Include a summary of your business operations, including:
    • Number of employees
    • Number of animals
    • Number of location of worksites
  • Limit: 3 job specifications per submission.
2

Job Specifications

Once you complete this section, if you plan to hire TN visa holders for multiple job categories, occupations, or professions, please select “Register New Job Specifications” to add another entry. Otherwise, click “Next” to proceed.

Please Provide a Brief Summary of Your Business Operation *
Do not delete
1

Business and Employer Information 

2

Job Specifications

3

References

4

TN Visa Agency and Indemnity Agreement

3

References

Reference #1

Name *
Relationship *
Phone *

Reference #2

Name *
Relationship *
Phone *

Reference #3

Name *
Relationship *
Phone *
1

Business and Employer Information 

2

Job Specifications

3

References

4

TN Visa Agency and Indemnity Agreement

4

TN Visa Agency and Indemnity Agreement

Agri-Placement Services, Inc.(“APS"), a New York Corporation, and *
(“Client”),
an employer having its principal place of business in the state of *

IN WITNESS WHEREOF, the parties have signed this Agreement this

day of
20
Client: *
Printed Name *
Title *
Signature *
Agency: *
Printed Name *
Title *
Signature *