CSB International, Inc. 119 Cooper Street - Babylon, NY 11702 Phone: 1-877-669-0717 Fax: 1-631-893-4547

I (first name) ___________________________________ (last name)__________________________________________________________ , the undersigned understand and agree that: 1. CSB International, Inc. is a United States Department of State designated sponsor for the Summer Work Travel Program and the participant is responsible to report to CSB International, Inc. while in the United States. 2. The program is designed to increase understanding among people of the world and is not to be used for the sole purpose of foreign language training or working. 3. The enrollment in the exchange program is primarily for cultural exchange, by being involved directly in the daily life of the United States, through temporary entry level employment and travel opportunities. 4. I am between the ages of 18 and 30 years old, I am a full time student at a post-secondary (college or university) institution. I will participate in the program only during my official university summer vacation, up to a maximum of 4 (four) months. 5. All the information provided in this application is true to the best of my knowledge, and I acknowledge that any false information may lead to an immediate dismissal from the program. 6. I must have appropriate medical and travel insurance during my program and I accept the insurance plan provided by CSB International, Inc. Pre-existing conditions are not covered. If I need an extension, I must contact CSB International, Inc. and I will be responsible to cover the extra fee for the insurance extension. 7. I am responsible to take a good care of Form DS-2019 and the cost of replacing lost or damaged forms must be borne by myself in any case ($50). 8. My Form DS-2019 is NOT a visa and I must take the form and other required documents to the United States Consulate to apply for the J-1 visa in my home country. I cannot participate in the program without a valid J-1 visa in my passport. The J-1 visa cannot be extended. 9. I am eligible to work solely within the dates specified on my Form DS-2019, not earlier and not later. 10. I will leave the United States upon completion of my program, on time for the first day of school and no later than 30 (thirty) days (otherwise known as the grace period) after the end date listed on the Form DS-2019. I am not authorized to work during the grace period however I can enjoy travelling opportunities. 11. In order to work and travel legally in the United States, I must validate my program within 30 (thirty) days from the start date of Form DS-2019. In other words, I must Check-in with CSB International, Inc. within 10 (ten) days of my date of arrival in the United States via www.csb-usa.com, confirming my housing address as well as the fact that I have arrived at my place of employment. If I do not have Internet access, I must call CSB International, Inc. at 1-877-669-0717 (toll-free). This is an extremely important step in the process of applying for the Social Security Number as well. 12. I can arrive no more than a week prior to the start date on my form DS-2019. I must report to the employer listed on my job offer form within 5 (five) days of my arrival in the United States. 13. I must maintain contact with CSB International, Inc. for the entire duration of my program and report in a timely manner any change in my housing and/or work address, or any issues experienced while in the United States. Should the participant leave the program early, the participant should notify CSB International, Inc. prior to departure. 14. If I accept a job offer from CSB International, Inc., a basic, entry level job will be arranged for me, much like one that a student in the United States would have during a school break. I will not normally be able to have a position that offers training in my future career, but I will certainly be able to learn a lot through my job if I have a positive attitude and I am open to new people and experiences. 15. If I accept a job offer from CSB International, Inc. I am in the agreement that I will work in that placement throughout the entire period covered by my Form DS-2019 and job offer agreement. 16. I do not have any medical condition that will prevent me from doing the job I have agreed to. This includes but it is not limited to allergies. 17. It may take up to 7 (seven) business days before I begin working and that my exact location, position, duties and responsibilities may vary during the period of my employment, due to arrival date, position availability, English level, skills required, weather conditions and other events out of the employer’s control. 18. The average participant receives minimum wage or slightly higher, depending on the location chosen. The compensation and expenses of my position are specifically detailed in the job offer agreement I must sign. 19. Overtime, tips and higher pay doing night shifts or second jobs are not guaranteed to anyone. 20. Permission to change jobs will be granted only if the employer has violated the terms of my job offer. CSB International, Inc must investigate any claim before taking a decision. If I leave without permission (in writing) from CSB International, Inc. my program may be terminated and I will be required to return home. I also understand that such termination may create legal difficulties that will affect my future travel, study or work in the United States at any time in the future. 21. If I am fired from my job for any specific reason concerning my attitude or actions, I may not be allowed to continue my program and I may be asked to return immediately home at my own expense. 22. If I accept a job offer from CSB International, Inc., the job offer could be revoked prior to or during my program, for reasons not prohibited by law or out of the employer’s control such as low business demand, weather, etc. Should my position or conditions of employment be revoked, CSB International, Inc. will assist me in finding alternative employment, but CSB International, Inc. makes no guarantee that it will be successful and that it can find a similar job, with similar conditions in a similar location. 23. Most of the CSB International, Inc. pre-arranged jobs include housing and I should expect the basics. I may be required to bring or purchase items necessary for a healthy lifestyle (for example, linens, towels, kitchen utensils and cookware). If I am placed in a site that provides housing I will be required to use this housing facility as the employer might have made a financial commitment to the housing site. 24. If my placement is self-arranged or walk-in, I am required to carefully read and check my job offer before submitting it for authorization to CSB International, Inc. I am also required to locate my own housing and submit a proof of my housing address to my local CSB International, Inc. International Representative with at least 30 (thirty) days prior to my arrival in the United States. 25. It is solely responsibility to cover the transportation expenses while in the program and I must report directly to my site of activity according to my start date and respecting the arrival instructions as written on my job offer form. It is also my responsibility to arrange transportation to and from work. 26. I will do my best to complete the program successfully and I agree to cooperate with CSB International, Inc. staff and follow any instructions they may give me. 27. I will check my e-mails at least once a week. I understand that CSB International, Inc. sends me updates and other important messages through the email to my email address provided on my application. 28. I must participate in all aspects of the program, including evaluation. 29. I must attend the orientation meeting scheduled to prepare me for the exchange experience. 30. Upon receipt of the Participant Handbook, I agree to read its contents. If I do not understand any part thereof, I will contact my international representative for clarification before I leave the country. 31. I must bring a minimum of $800 to support myself once I arrive in the United States. This amount is exclusive of the housing first month rent, housing deposit & transportation. It may take up to three weeks until the first paycheck will be issued. 32. To obey all United States federal, state and local laws. If I break the law, I understand that CSB International, Inc. will not be able to help me and I will be terminated from my program. 33. I will respect all CSB International, Inc. and Department of State Program rules, in regards with my employment and program participation, including the rules of conduct required by the employer. 34. CSB International, Inc. may provide participant’s information to third parties for marketing purposes. 35. All photos and testimonials provided to CSB International, Inc. during my participation in the program can be used for CSB International, Inc. promotional purposes unless I decline by providing a written notification. My signature below confirms that I have read, understood and agreed to abide by the rules, terms and conditions of CSB International, Inc. Summer Work Travel Program.

Summer Work Travel Applicant (signature)__________________________________________________

International Representative (company name) _______________________________________________

Date (Month) __________ (Day) __________ (Year) __________

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My signature below confirms that the above mentioned applicant had enough time to read, comprehend and ask questions in regards to the terms and conditions of the program.

Name of Recruiter ___________________________________________________

Signature ____________________________________________________