Non-US citizens: DO NOT begin until you have your immigration and naturalization documents available that establishes both your identity and legal immigration status (e.g., passport, visa, EAD card, I-20, DS-2019, I-797, or any other supplemental status documentation required to confirm your identity and legal immigration status). The Department of Energy also requires current and complete CVs/resumes in PDF format to accompany the registration form.
Legal First/Given Name:
Middle Initial/Name: Please check box if no middle initial/name.
Legal Last/Family Name: Legal First and Last Name must be entered as it appears on photo id
Mobile Phone Number: Domestic or International e.g. (xxx) xxx-xxxx or +xx xx xxxx xxxx
Email Address:
Alternate Email Address:
Are you a US Citizen?: Yes No
Employer/Affiliation Name:
Business Title:
Address Line 1: Street Address or Post Office Box Number
Address Line 2: Apartment, Suite, Unit, Building, Floor
Address Line 3:
City/Town/Locality:
State/Province:
Zip/Postal Code:
Country: Please Select a Country Afghanistan - Islamic State Of Albania Algeria American Samoa Andorra Angola - Republic Of Antarctica Antigua And Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegovina Botswana Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo (Brazzaville) - Republic of Congo Congo (Kinshasa)- Democratic Republic of Congo Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia (Tahiti) French Southern Territories Gabon Gambia Gaza Strip Georgia Germany Ghana Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic Of) Iraq Ireland Isle of Man Israel Italy Ivory Coast - Cote D'Ivoire Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos People's Democratic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia - The Former Yugosla Madagascar - Republic Of Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia - Federated States Moldova - Republic Of Monaco Mongolia Montenegro - The Former Yugosla Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Zealand Nicaragua Niger Nigeria North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Palau Romania Russian Federation Rwanda Saint Kitts And Nevis Saint Lucia Saint Vincent And The Grenadin San Marino Sao Tome And Principe Saudi Arabia Senegal Serbia, Republic of Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan, Republic of Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania - United Republic Of Thailand Togo Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States UNKNOWN Uruguay Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Western Samoa Yemen Zambia Zimbabwe
Work Phone Number: Domestic or International e.g. (xxx) xxx-xxxx or +xx xx xxxx xxxx
Work Fax Number: Domestic or International e.g. (xxx) xxx-xxxx or +xx xx xxxx xxxx
Arrival Date - Time: 2024 2025 / January February March April May June July August September October November December / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 — 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 : 00 15 30 45 Year / Month / Day - Hour : Minute
Depature Date - Time: 2024 2025 / January February March April May June July August September October November December / 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 — 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 : 00 15 30 45
Purpose/Special Instructions:
Additional information is required in accordance with the Unclassified Foreign National Access Program (FNAP) mandated by U.S. Department of Energy Order DOE Order 142.3B.
Visit or Assignment Reason: Please select a reason Tour Experiment Research User Equipment Repair/Installation CRADA HEU IPP Information Meeting MPC&A Media Event WFO IAEA Inspection IAEA Training Maintenance Workers Employment (including interviews) Speech or Presentation Commercial/Contractor Services Person - Not Work Related Car-pool Conference Attendance Training
Gender: Male Female
City of Birth: Do Not List Province
Country of Birth: Please Select a Country Afghanistan - Islamic State Of Albania Algeria American Samoa Andorra Angola - Republic Of Antarctica Antigua And Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegovina Botswana Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo (Brazzaville) - Republic of Congo Congo (Kinshasa)- Democratic Republic of Congo Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia (Tahiti) French Southern Territories Gabon Gambia Gaza Strip Georgia Germany Ghana Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic Of) Iraq Ireland Isle of Man Israel Italy Ivory Coast - Cote D'Ivoire Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos People's Democratic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia - The Former Yugosla Madagascar - Republic Of Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia - Federated States Moldova - Republic Of Monaco Mongolia Montenegro - The Former Yugosla Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Zealand Nicaragua Niger Nigeria North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Palau Romania Russian Federation Rwanda Saint Kitts And Nevis Saint Lucia Saint Vincent And The Grenadin San Marino Sao Tome And Principe Saudi Arabia Senegal Serbia, Republic of Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan, Republic of Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania - United Republic Of Thailand Togo Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States UNKNOWN Uruguay Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Western Samoa Yemen Zambia Zimbabwe
Date of Birth: 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Country of Citizenship: Please Select a Country Afghanistan - Islamic State Of Albania Algeria American Samoa Andorra Angola - Republic Of Antarctica Antigua And Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegovina Botswana Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo (Brazzaville) - Republic of Congo Congo (Kinshasa)- Democratic Republic of Congo Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia (Tahiti) French Southern Territories Gabon Gambia Gaza Strip Georgia Germany Ghana Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic Of) Iraq Ireland Isle of Man Israel Italy Ivory Coast - Cote D'Ivoire Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos People's Democratic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia - The Former Yugosla Madagascar - Republic Of Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia - Federated States Moldova - Republic Of Monaco Mongolia Montenegro - The Former Yugosla Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Zealand Nicaragua Niger Nigeria North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Palau Romania Russian Federation Rwanda Saint Kitts And Nevis Saint Lucia Saint Vincent And The Grenadin San Marino Sao Tome And Principe Saudi Arabia Senegal Serbia, Republic of Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan, Republic of Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania - United Republic Of Thailand Togo Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States UNKNOWN Uruguay Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Western Samoa Yemen Zambia Zimbabwe
Country of Second Citizenship: Please Select a Country Afghanistan - Islamic State Of Albania Algeria American Samoa Andorra Angola - Republic Of Antarctica Antigua And Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegovina Botswana Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo (Brazzaville) - Republic of Congo Congo (Kinshasa)- Democratic Republic of Congo Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia (Tahiti) French Southern Territories Gabon Gambia Gaza Strip Georgia Germany Ghana Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic Of) Iraq Ireland Isle of Man Israel Italy Ivory Coast - Cote D'Ivoire Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos People's Democratic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia - The Former Yugosla Madagascar - Republic Of Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia - Federated States Moldova - Republic Of Monaco Mongolia Montenegro - The Former Yugosla Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Zealand Nicaragua Niger Nigeria North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Palau Romania Russian Federation Rwanda Saint Kitts And Nevis Saint Lucia Saint Vincent And The Grenadin San Marino Sao Tome And Principe Saudi Arabia Senegal Serbia, Republic of Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan, Republic of Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania - United Republic Of Thailand Togo Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States UNKNOWN Uruguay Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Western Samoa Yemen Zambia Zimbabwe
Field of Research:
Kind of Business: Your kind of business or organization (i.e. government, laboratory, university, corporation)
Title, Position, or Occupation: Your title, position, or duties
All resumés must include: • Include full name at the top of the page. Do not include address, e-mail address, or phone numbers. • A description of your research/science interests and technology specialties. • All educational levels and institutions and years must be noted. • All work positions with no gaps in time. If there is a gap of 6 months or more, reasoning for gap is required (i.e., layoff, unemployed, extended vacation, starting family, etc.). • All publications (if you have no publications, please indicate). • Do not include any Personally Identifiable Information (PII) on your resumé (i.e., date of birth, city of birth, etc.).
All resumés must include:
Resumé: File types accepted: PDF File size accepted: 10MB
Education Background Bachelor's (or equivalent):
I have 0 1 2 3 Bachelor's Degree(s).
Education Background Master's (or equivalent):
I have 0 1 2 3 Master's Degree(s).
Education Background Doctoral (or equivalent):
I have 0 1 2 3 Doctoral Degree(s).
Other Certification(s)/Training(s): For other applicable certification(s) or training(s), please enter them above. If none, please put N/A.
For more information see the U.S. Citizenship and Immigration Services Website
Select your legal file type: LPR EAD EAD-STEM OPT Other
LPR Number:
LPR Expiration Date: 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 2042 2043 2044 January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
LPR Document: File types accepted: BMP, JPEG, JPG, PDF, or PNG File size accepted: 10MB
Passport Number:
Passport Expiration Date: 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 2042 2043 2044 January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Passport Country of Issue: Please Select a Country Afghanistan - Islamic State Of Albania Algeria American Samoa Andorra Angola - Republic Of Antarctica Antigua And Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegovina Botswana Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo (Brazzaville) - Republic of Congo Congo (Kinshasa)- Democratic Republic of Congo Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia (Tahiti) French Southern Territories Gabon Gambia Gaza Strip Georgia Germany Ghana Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic Of) Iraq Ireland Isle of Man Israel Italy Ivory Coast - Cote D'Ivoire Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos People's Democratic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia - The Former Yugosla Madagascar - Republic Of Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia - Federated States Moldova - Republic Of Monaco Mongolia Montenegro - The Former Yugosla Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Zealand Nicaragua Niger Nigeria North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Palau Romania Russian Federation Rwanda Saint Kitts And Nevis Saint Lucia Saint Vincent And The Grenadin San Marino Sao Tome And Principe Saudi Arabia Senegal Serbia, Republic of Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan, Republic of Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania - United Republic Of Thailand Togo Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States UNKNOWN Uruguay Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Western Samoa Yemen Zambia Zimbabwe Passports obtained from a foreign embassy located in the United States arenot issued by the United States Government but rather are issued by thatforeign country government.
Passport Document: File types accepted: BMP, JPEG, JPG, PDF, or PNG File size accepted: 10MB
Visa Type: Please Select a Visa Type Canadian Citizen, Visa Not Required N/A - Not traveling to U.S. VISA A-1 - Diplomatic Visa VISA A2 - Diplomatic Visa VISA B1 - Business Visa VISA B2 - Pleasure Visa VISA E-1 - Treaty Trader VISA E2 - Treaty Trader/Investor Visa VISA E3 - Australians in speciality occupations VISA EAD - Employment Authorization Document VISA F-2 - Spouse or Child of F-1 VISA F1 - Student Visa VISA G-2 - Representative of International Organization VISA G4 - Representative of International Organization VISA H1 - Temporary Employment Visa VISA I - Foreign Media Representative VISA J1 - Exchange Visitor Visa VISA J2 - Exchange Visitor Independent Status VISA L1 - Intracompany Transferee VISA O1 - Extraordinary Ability (science/art/education/etc) VISA O2 - Assist an O-1 - Assist an artistic or athletic act VISA TN - Canada/Mexico Professionals VISA V1 - Spouse of an Lawful Permanent Resident(LPR) VISA V2 - Child of an Lawful Permanent Resident(LPR) Visa Waiver - Business Visa Waiver - Pleasure Visa Waiver does not require a Visa Number or Visa Expiration Date
Visa Number: Do NOT use the control number, please use the red number that appears in the lower right side of the visa
Visa Expiration Date: 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 2042 2043 2044 January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Visa Document: File types accepted: BMP, JPEG, JPG, PDF, or PNG File size accepted: 10MB
Other required form of identification: Please Select a Document Type ADIT Stamp - valid temporary proof of Permanent Residency (Form I-551) Application to adjust to LPR (Form I-485) Approval Notice (Form I-797) Arrival-Departure Record (Form I-94) Asylum Status (Form I-589) Authorization for Parole (Form I-512) Certificate of eligibility for F-1 status (Form I-20) Certificate of eligibility for J-1 status (Form DS-2019) Employment Authorization Document/Card Permanent Resident Card (Green Card) SEVIS number on the I-20 form for the F-1 student visa extension
USCIS Form Number:
Expiration Date on USCIS Form: 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 2042 2043 2044 January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
USCIS Document: File types accepted: BMP, JPEG, JPG, PDF, or PNG File size accepted: 10MB
Employer Name:
Address Line 1:
Address Line 2: