Green Card Request Form

Employee Information

Employee First Name

Employee Last Name

Employee Email Address

Employee Phone Number

Position Information

Current Job Title

Rate of Pay

Employment Status

Full TimePart TimeContingent

How many hours per week?

Primary Worksite Location

Secondary Worksite Location

Other Worksite Locations

Brief Description of Job Duties

Please upload copy of official job description (if available)

Department Information

Department Requesting Services

Department Representative Name

Department Rep. Phone Number:

Department Rep. Email Address

Name of Person Completing Form

Phone Number of Person Completing Form (if not Department Rep.)

Email Address of Person Completing Form (if not Department Rep.)

Additional Comments:

If you have questions about completing this form, please call 248-519-9900.

Henry Ford/HAP Green Card Request Form