J-1 Visa Waiver Application Instructions

 General Instructions  

• Provide information for all sections and subsection headings outlined below and order them in the completed application as they appear in the Application Package Content and Order listing below.
• Print or stamp the applicant physician's review or case number from the United States Department of State (DOS) on all application pages.

 J-1 Visa Waiver Application Package Content and Order

1.  Cover letter- The cover letter shall request the department to act as an interested governmental agency in recommending waiver of the home country residency requirement for the named J-1 physician. The cover letter should list the contents and order of the application; describe the employing facility; services offered and service area.

2. Information required from sponsoring health facility for which the applicant physician will be employed: 

a.       A letter from the sponsoring health facility employer that includes the following: 

·         Requests that California’s Department of Health Care Services (Department) act as an interested government agency and recommend a waiver for the J-1 Waiver applicant physician

·         Describes the health facility including the nature and extent of its medical services

·         Summarizes how the health facility has attempted to locate qualified American physicians

·         Describes the applicant physician’s qualifications, proposed responsibilities, and how his/her employment will satisfy important unmet health care needs of a medically underserved community

·         States unequivocally that the facility is offering the applicant physician at least three years of employment in a job consistent with the Department’s mission, a description of the critical need of the health facility’s service area and how the health facility will assure that the applicant physician will serve that need and describes the detailed plans for the applicant physician during and beyond the three year obligation 

·         Describes the effect on the underserved if the waiver application is denied. 

b.       Copy of a valid contract of employment between the J-1 Visa Waiver applicant physician and the sponsoring health facility of not less than three (3) years for no less than forty (40) hours per week providing primary care services at a salary comparable to the area. Refer to Foreign Labor Certification Data Center Online Wage Library http://www.flcdatacenter.com/OesWizardStart.aspx for salary verification. The contract shall not include a non-compete clause enforceable against the applicant physician

c.      Copy of the health facility’s federally designated Health Professional Shortage Areas (HPSA), Medically Underserved Areas/Populations (MUA/MUP) status or Mental Health Professional Shortage Areas (MHPSA) status for psychiatrists (http://datawarehouse.hrsa.gov or http://bhpr.hrsa.gov) for all sites where the applicant physician will or might be providing services

d.       Documentation from state/local health care officials stating the need for services of the applicant physician

e.     Evidence of recruitment and retention efforts during the past year made to American candidates for the same position the health facility intends to fill with a foreign applicant physician (e.g., copies of advertisements, agreements with placement services, flyers for health fairs, etc., all with dates clearly identified).

 3. Information required from the J-1 Waiver applicant physician: 

a.       Copy of the completed Waiver Review Application Data Sheet (form DS-3035)

b.      Copy of The DOS File Number Notification (aka third party barcode page) and the DOS case number must appear on every page submitted with the application

c.       Physician curriculum vitae (CV) that includes physician's name, address, date of birth, and city and country of birth

d.      Letters of recommendation for J-1 Visa Waiver applicant physician

e.       Copy of passage of examinations required by U.S. Citizenship and Immigration Services (USCIS): either Flex parts I and II OR all 3 steps of the United States Medical Licensing Examination (USMLE)

f.        Legible copy of California medical license OR a copy of the application to the Medical Board of California AND evidence of receipt by the Medical Board of California

g.       Legible copies of all DS-2019 (formerly IAP-66) of the applicant physician covering every period (year) he/she was J-1 Visa status     

h.       Legible copies of I-94 of applicant physician and his/her family members (front & back)

i.         Three (3) separate attestations, signed and notarized:

·         An attestation or statement of "No Objection": The applicant physician must submit a copy of a statement of no objection from their home government if he/she is contractually or financially obligated to return to the home country.  In the event that the applicant physician is NOT contractually or financially obligated to return to the home country, the applicant physician must submit a signed and notarized attestation to that effect

·         An attestation from the applicant physician that he/she has no other waiver request pending with another government agency

·         An attestation from the applicant physician of his/her commitment to comply with J-1 Visa Waiver requirements.             

4. California Authorization for Release of Information (PDF) form with an original signature by the applicant physician.  The applicant must identify the attorney, employer, or other designated recipient to discuss his/her J-1 Visa Waiver application

5. Federal G-28 or letter if represented by an attorney (http://www.uscis.gov/files/form/g-28.pdf

Applications must be submitted in the order described above. Submit two unbound single-sided copies of the complete application to the J-1 Visa Waiver Program. Index tabs are appreciated. 

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