ITA-4143P-3 SABIT Program Participant Application

Form No. ITA-4143P3

OMB Number: 0625-0225

This application is distributed free of charge and may be copied

Expires: 08/31/2024

SABIT/САБИТ

Special American Business Internship Training Program

A Program of the U.S. Department of Commerce

Специальная Американская Программа Деловых Стажировок

Программу спонсирует Министерство Торговли США

[Name of Program Session]

[Dates of Program Session]

[(Names of the country(ies) the program session is for)]

Please read all the information below before starting the application. /Перед подачей заявки ознакомьтесь с информацией, приведенной ниже.

Description of the program/Описание программы

The U.S. Department of Commerce’s Special American Business Internship Training (SABIT) program has established a program to train up to [number] professionals from the [name of industry sector]. SABIT has successfully trained almost 7,000 executives and scientists from Eurasia and other regions [region/country may change depending on the program]. SABIT provides trainees the opportunity to become familiar with a U.S. industry sector and its regulations, establish valuable business relationships, learn about and purchase innovative technologies, equipment, and services, and come to understand market-based business concepts.

[Russian, or other language, translation of above paragraph.]

The program will be [number] weeks in length, beginning with one week of training which may include sessions on policy, legislation, standards, certification, business plan development, cross-cultural negotiations and management for both associations and businesses. This will be complemented by site visits and meetings with U.S. companies in the [industry sector] and supporting industry associations. The main goal of the program is to introduce participants to the U.S. [industry sector].

[Russian, or other language, translation of above paragraph.]

Description of the Applicant/Характеристика заявителя

The program will cover a variety of [industry sector topics] including but not limited to [industry sector topics]. The program is designed for [description of ideal candidate]. Candidates who apply to participate in the training program should be in a position of significant responsibility and have at least three years of management experience.

[Russian, or other language, translation of above paragraph.]

The program will be interpreted from English into Russian [or other language] by professional, simultaneous interpreters. Therefore, participants must be fluent in [language] or English.

[Russian, or other language, translation of above paragraph.]

Applicants are screened and selected by the U.S. Department of Commerce based on their professional and educational achievements and experience in specific industrial sectors. SABIT’s Washington, DC office will make final determinations regarding which applicants are selected for training. Those selected will be notified by a SABIT official from the United States or from a SABIT or USG representative in their home country or region.

[Russian, or other language, translation of above paragraph.]

What the Program Provides/Что предусматривает программа

For those selected to participate in this program, the U.S. Government will pay for round-trip airfare from a designated site to the United States, lodging, a comprehensive training program, interpreters/facilitators, emergency medical insurance, and a stipend to offset the costs of meals and incidental expenses.

[Russian, or other language, translation of above paragraph.]

Each participant must provide his or her own transportation to the designated departure site and possess a valid international passport on which to travel. Departure sites are Moscow, Kyiv, Almaty, or a connection in Europe. Each SABIT participant will travel on a B-1/B-2 business visa, which prohibits the receipt of a salary or honorarium. Participants are responsible for the cost of the U.S. visa. SABIT will provide an invitation letter to support your visa application. SABIT participants may not seek permanent employment in the United States.

[Russian, or other language, translation of above paragraph.]

Rules and Responsibilities/Правила и обязанности

Upon completion of their training, participants must return to their home countries. Participants may not extend their stay in the United States after the training even if the participant held a visa prior to applying to the SABIT Program. If the participant remains, the participant will be reported to the U.S. Embassy in their home country, informing them of the program rule breach. This may affect whether the participant can get a visa in the future and may affect future visa applicants from his or her country.

[Russian, or other language, translation of above paragraph.]

Please be advised that the SABIT program will conduct a due diligence review of both the applicant and his/her company via several different means, which may include web searches, credit bureau reporting agency searches, through the Office of Foreign Assets Control (OFAC) at the U.S. Department of Treasury, and other sources. If there are any sanctions against the Applicant or the Applicant’s company or if there are any legal or ethical concerns found, he/she will not be considered for the program. If the applicant has already been invited before the information was found, his/her invitation may be revoked, or he/she may be terminated from the program if he/she is already in the United States. This review is directed only at serious matters involving U.S. government sanctions, or serious legal or ethics issues, and has resulted in adverse action by the SABIT program only very rarely.

[Russian, or other language, translation of above paragraph.]

Any material misrepresentation on the part of the applicant either orally or in writing will automatically be grounds for disqualification or expulsion from the program whether the participant is already selected or in the United States.

[Russian, or other language, translation of above paragraph.]

This program is for professionals who have not participated in a SABIT Program. OR This program is for SABIT Program alumni.

[Russian, or other language, translation of above paragraph.]

How to Apply/Как подать заявку

Applications must be accompanied by a letter from the candidate’s supervisor in his or her employing organization which contains the following: A description of the applicant's present duties and permission for the Applicant to participate in the program during the specified dates. If the Applicant is the director of the organization, a letter from his/her business partner with a brief description of joint projects should be attached to the application form. If a letter is written in Russian, the English translation should also be attached. The application form and letter should be completed in both English and [language]. There are no fees of any kind associated with completing this application. There is no cost for applying, processing the application, or being selected to participate in the program, other than the cost of the U.S. visa, if the participant does not already have one, and resulting costs and transportation to the departure city.

[Russian, or other language, translation of above paragraph.]

PLEASE READ ALL INSTRUCTIONS BEFORE STARTING THE APPLICATION/ПЕРЕД ПОДАЧЕЙ ЗАЯВКИ ОЗНАКОМЬТЕСЬ СО ВСЕМИ ИНСТРУКЦИЯМИ, ПРИВЕДЕННЫМИ НИЖЕ:

APPLICATIONS MUST BE RECEIVED NO LATER THAN [Date]/ЗАЯВКИ ДОЛЖНЫ БЫТЬ ПОДАНЫ НЕ ПОЗДНЕЕ ПОНЕДЕЛЬНИКА [Date]

Please note: this application will take about three hours to complete. It must be completed in one sitting. It's a good idea to type out your answers in a separate document first to avoid losing your work.

[Russian, or other language, translation of above paragraph.]

The application will not be considered if it is sent by email.

[Russian, or other language, translation of above paragraph.]

SABIT

SPECIAL AMERICAN BUSINESS INTERNSHIP TRAINING PROGRAM

СПЕЦИАЛЬНАЯ ПРОГРАММА ДЕЛОВЫХ СТАЖИРОВОК В США

[Program Name]

[Program Dates]

[(Names of participating countries)]

I. GENERAL INFORMATION/ПЕРСОНАЛЬНАЯ ИНФОРМАЦИЯ

Name (passport spelling)

________________________________________________________________________________

(Last Name) (First Name) (Patronymic)

Ф.И.О. (как написаны в паспорте)

_______________________________________________________________________________

(Фамилия) (Имя) (Отчество)

Place of

Employment: ____________________________________________________________________

(Complete Company Name)

Место работы: ___________________________________________________________________

(Полное название компании)

Position/Title: __________________________________________________________________

Должность: _____________________________________________________________________

Work Tel./Раб.Тел.: __________________ Mobile Tel./Мобильный Тел: ____________________

Work E-mail/Адрес рабочей электронной почты: _______________________________________

Personal E-mail/Адрес личной электронной почты: _____________________________________

Company Website/Web-страница: _________________________________________________

Work Address: ___________________________________________________________________

(Street, Building, City, Index)

Рабочий адрес: __________________________________________________________________

(Почтовый индекс, улица, дома или почтового ящика, город)

Home address: ___________________________________________________________________

(Street Name and Number) (Apartment Number) (City, Index)

Домашний адрес: _____________________________________________________________

(Улица и номер дома) (Номер квартиры) (Город, почтовый индекс)

Home Telephone/Домашний телефон: ________________________________________________

Preferred Mailing Address/Предпочитаемый почтовый адрес: Home/Дом Work/Работа

Sex/Пол.: Female/Жен. Male/Муж

Marital Status/Семейное положение: Single/Холост Married/Женат, замужем

Citizenship/Гражданство: __________________________________________________________

Full Name of Spouse/Полное имя супруга(и): _________________________________________

Spouse’s place of work, position, and telephone number/Место работы супруга(и), должность и рабочий номер телефона:

________________________________________________________________________________

Other contact numbers where you can be reached (please list alternative telephones including city codes)/ Укажите другие номера телефонов, включая код местности, по которым Вас можно найти:

Tel./Тел. _____________________________ Name/Имя: ________________________________

Relationship/Кем приходится:

Friend/Товарищ Co-worker/Сослуживец Spouse/Супруг/а

Relative/Родственник Other/Другое

In case of emergency, whom should we contact? (include name, e-mail, and telephone number)/В случае необходимости, с кем мы можем связаться по Вашей просьбе (Имя, адрес электронной почты, и номер телефона):

How did you learn about the SABIT Program/Как Вы узнали о программе САБИТ?

II. EDUCATION/ОБРАЗОВАНИЕ

A. List all post-secondary education including professional education, beginning with most recent (attach additional pages as needed)/Перечислите Ваше образование после окончания средней школы, начиная с последнего учебного заведения, которое Вы окончили:

Dates Даты	Institute/University Учебное заведение/Город	Major Subject Основная специальность	Degree/Date Received Квалификация/Научная степень/Дата диплома

B. List all U.S. Government-funded programs in which you have participated (attach additional pages as needed)/Перечислите все образовательные и культурные программы Правительства США, в которых Вы участвовали (если необходимо, воспользуйтесь дополнительными листами бумаги):

Dates/Даты	Name of U.S. Government Sponsoring Agency/ Название Американской организации-спонсора	Topic of Program/Тема программы

С. Knowledge of English: Please rate your knowledge of English in the following areas:

Знание англ. языка: Пожалуйста, оцените Ваш уровень владения англ. языком по следующей шкале:

	Excellent Свободно	Good Хорошо	Fair На базовом уровне	Poor Слабо
Reading/Чтение
Writing/Письмо
Comprehension/Понимание
Speaking/Разговорная речь

List any other languages that you know/Перечислите другие языки, которыми Вы владеете:

III. BUSINESS AND EMPLOYMENT EXPERIENCE/ПРОФЕССИОНАЛЬНЫЙ ОПЫТ

A. List your business and employment history for the past ten years ONLY, beginning with most recent/Опишите Ваш профессиональный опыт за последние 10 лет, начиная с настоящего времени:

Dates/Даты (Мес, день, год)	Name of Organization Название организации	City Город	Position/Title Должность	Responsibilities and duties Должностные обязанности (Дайте краткий точный ответ)

B. If you are not a SABIT Program alumnus/a, please list three professional references (names, addresses and phone numbers)/Перечислите трех человек, которые могли бы дать Вам профессиональную характеристику:

Name/Имя и фамилия	Company Name, Address, Telephone, and email address/Компания, адрес, телефон и электронная почта	Professional relationship/ Профессиональные взаимоотношения

A. Passport and Travel Information/Информация о паспорте и поездках за рубеж:

Примечание: Просим Вас учесть, что информация о Вашем международном паспорте очень важна, так как данная информация необходима для оформления пропуска для посещения принимающих американских компаний.

Do you have an external passport? /Наличие международного паспорта

Yes/Да No/Нет

Place of Birth (City, Country)/Место рождения (город, cтрана

Date of Birth/Дата рождения (in MM/DD/YYYY format):

Have you ever applied for a U.S. visa/Обращались ли Вы когда-нибудь за визой в США?

Yes/Да No/Нет

When/Where/Если Да, то когда и где:

Were you granted a U.S. visa/Была ли выдана Вам виза в США? Yes/Да No/Нет

If yes, what type? /Если да, какой тип визы?

Have you ever applied for immigration to the U.S./Подавали ли Вы документы на иммиграцию в США?

Yes/Да No/Нет

If yes, when/where/Если да, то когда и где:

B. List previous travel abroad (attach additional pages as needed)/Перечислите все Ваши поездки за границу (если необходимо, приложите дополнительные листы бумаги):

Country/Страна	Dates/Даты	Sponsor/Спонсор	Purpose/Цель

Please list any contacts you have in the United States (including family, friends, business associates, and acquaintances)/Перечислите, пожалуйста, все Ваши знакомства в США (включая родственников, друзей, деловых партнеров и знакомых):

V. STATEMENTS OF PURPOSE/ОБОСНОВАНИЕ ЦЕЛЕЙ

The following information is very important and will help SABIT elaborate the most effective training program for you. Please give the most detailed answers to the following questions. /Следующая информация очень важна и поможет САБИТу разработать максимально полезную для Вас программу обучения. Дайте, пожалуйста, максимально подробные ответы на все нижеследующие вопросы.

1. Current enterprise description/Характеристика Вашего предприятия/компании:

Name of enterprise/Название предприятия/компании:

Type of enterprise (i.e. industry sector: types of goods or services provided)/Тип предприятия (т.е. название отрасли по типу производства товаров или предоставляемых услуг):

The market for your product or service is/Каков рынок для Ваших услуг или продукции:

local/местный national/национальный

regional/региональный international/международный

(If international, please list countries/какие страны):

Who are your customers?/Кто Ваши клиенты?

state enterprises/госпредприятия individuals/частные лица

private enterprises/частные компании other/другое

How many people work at the firm? /Сколько людей работают на Вашем предприятии?

Annual gross revenue (in US$)/Годовой валовый доход (в долларах США):

Ownership of your company/Владельцы Вашего предприятия:

If it is owned by more than one entity or individual, please provide the ownership breakdown by percentage/Если владельцев несколько, укажите, пожалуйста, их долю в процентном отношении):

2. Program Questions for Alumni

SABIT Program alumni will be eligible to attend a week-long program that includes a visit to a trade show, with the possibility of some company visits.

It is a competitive process, and we would like to know what you have done in the years since you came on the program.  The following are examples of subjects on which we would like to hear from you, but discussion of any post-participation matters would be welcome.

Please be specific, including dates and descriptions of any purchases, legislation, and names of contacts.  You must address at least one of the following questions, but you are not limited to just one.

SABIT Program staff will review applications and may contact you for further information.

With respect to your company, examples of subjects that you might address include how your participation has affected your or your company:

• Purchases of U.S. equipment, services, or technology

• Advocacy for corporate or legislative reforms to improve the business environment in your country

• Role in new or existing business associations

• Use of new technologies, management operations, or production processes

• Development of new products or services, in which your SABIT participation played a role

• Doing business with the companies of your fellow SABIT alumni.

With respect to your personal experience, examples of subjects that you might address include:

• Whether you have obtained any certifications with international quality control institutions

• Whether you have spoken at any conferences or have published any articles about what you learned while participating in the SABIT Program

2. Program Questions for non SABIT Program Alumni

1. Describe your present employing organization (please be specific in terms of private, non-profit, or public sector, the date it was formed, what the mission and goals are, what areas of work it is involved in, how it is structured and /or types of goods and services it provides)/Дайте характеристику организации, в которой Вы работаете в настоящее время (пожалуйста, укажите точно вид собственности – частная, некоммерческая или государственная, дату основания, цели и задачи, в какой сфере она работает, структуру и вид услуг, которые она предоставляет):

2. Please give a description of your specific responsibilities in the organization. This must include: your title; the name and title of the person whom you work; the name of the division or department for which you work; and its major function within the enterprise; how many employees report to you directly; some of the major problems you have encountered in your work and how you think this program might assist you with those problems; and, any other information you think would be of interest/Опишите свои должностные обязанности в Вашей организации. Это описание должно включать Вашу должность, имя и должность Вашего непосредственного начальника, название отдела или департамента, в котором Вы работаете и его функции в системе Вашей организации; сколько сотрудников находятся в Вашем подчинении, с какими трудностями Вы постоянно сталкиваетесь в своей работе, и каким образом данная стажировка поможет Вам решить эти проблемы. Вы можете также включить любую другую информацию, которую Вы считаете необходимой.

3. Describe your goals in coming to the United States for an internship program, and how these relate to your short-term and long-term career goals/Какие задачи Вы ставите перед собой в связи со стажировкой в США? Как они относятся к краткосрочным и долгосрочным целям в Вашей карьере?

4. How do you plan to apply the knowledge you will gain on the SABIT training program to your work back home -- both in your company and the country as a whole? What makes you a good candidate for this program?/Как Вы планируете применить знания, полученные во время стажировки САБИТ на своем предприятии и в масштабах Вашей страны? Какие качества делают Вас подходящим кандидатом на участие в данной программe.

Rank each topic from 1 – 5 according to your professional needs and requirements. Please rank each topic carefully as this will determine program content and structure/Оцените каждую тему по шкале от 1 до 5, исходя из ваших профессиональных потребностей и интересов. Оценивая каждую тему, проявляйте особую тщательность, поскольку результаты оценки повлияют на содержание и структуру программы.

Ranking/Шкала оценок:

1 – most important/наиболее важная тема

2 – very important/очень важная тема

3 – important/важная тема

4 – somewhat important/не очень важная тема

5 – not important or not applicable/несущественная или не соответствующая программе тема

[List of topics and 2-3 questions, below, will change depending on the industry sector]

Please provide information about specific projects, joint ventures, or business relationships you would like to develop with U.S. companies. (List the names of particular companies or organizations you have in mind.) /Предоставьте информацию о конкретных проектах, совместных предприятиях или деловых взаимоотношениях, которые вы бы хотели разработать с компаниями из США. (Укажите названия конкретных компаний или организаций, которые вы подразумеваете.)

What specific types of technologies or equipment are you interested in? Please list the type of equipment and the names of U.S. companies you would like to meet with to discuss their product offerings. /В каких именно типах технологий или оборудования вы заинтересованы? Перечислите тип оборудования и названия компаний США, с которыми вы бы хотели встретиться, чтобы обсудить их ассортимент.

Are there other topics that are of interest to you that you would like to see addressed in the program? /Есть ли другие темы, которые вас интересуют, которые вы бы хотели рассмотреть в этой программе?

PROGRAM RULES AGREEMENT/СОГЛАШЕНИЕ О ПРАВИЛАХ ПРОГРАММЫ

It is impractical to list all U.S. laws and even all expectations of SABIT Participants. Here are a few things you should know. Everyone should be treated with respect and everyone’s time should be respected as well. Remember, you represent yourselves, your companies, and your countries. Conduct yourself accordingly.

[Russian, or other language, translation of above paragraph.]

If selected, I agree to comply with all regulations of the program and all local and national laws of the United States. I understand that I may be terminated from the program for conduct that, while not illegal, is improper and inconsistent with the operation of the SABIT Program. Examples of such conduct are public misbehavior that causes embarrassment to the United States government, substance abuse of any sort, harassment or abusive behavior of any sort towards a fellow participant, a SABIT employee or contractor, or anyone else with whom the participant comes into contact in the course of his/her participation in the program, and damage, destruction, or abuse of property belonging to a person or entity other than the participant.

[Russian, or other language, translation of above paragraph.]

I understand that all meetings are mandatory and can only be missed for illness or if pre-approved by SABIT staff. I understand that if I miss any meetings without an approved excuse, my program participation may be terminated.

[Russian, or other language, translation of above paragraph.]

I understand that even excused absences may affect whether I receive a certificate upon completion of the program.

[Russian, or other language, translation of above paragraph.]

I affirm that the information submitted in this application is complete and accurate. I understand that providing false information on this application or during the interview will automatically disqualify me from participation in the SABIT program. If I am selected for participation in the program, and it is determined during the training that any of the information provided in this application or during the interview was false, I understand that this will mean immediate dismissal from the program.

[Russian, or other language, translation of above paragraph.]

I understand that while in the United States, he SABIT Program will try to arrange single (private) rooms for all participants, but I may be asked to share my hotel room with one other individual from the training group (of the same sex). This will only occur in rare circumstances, when single rooms are unavailable. I understand if this occurs, separate beds will be provided. I agree that this type of housing arrangement presents no difficulties.

[Russian, or other language, translation of above paragraph.]

I understand that I will be provided with medical insurance to be used only for emergency situations and not for routine medical care or treatment for any pre-existing medical or dental condition. I further understand that I will be required to pay all deductibles and other miscellaneous expenses not covered by the insurance. I understand that I may purchase my own travel and/or health insurance before departing for the United States. If I choose to do so, this may act as additional coverage for me while I am on the SABIT program.

[Russian, or other language, translation of above paragraph.]

I understand that the U.S. visa obtained in connection with my SABIT program training is valid only for temporary training and is not valid for employment in the United States or for travel not related to the SABIT training.

[Russian, or other language, translation of above paragraph.]

I declare my intent to return to my home country with the SABIT delegation at the end of my training as a SABIT program participant, even if I had a visa prior to being accepted into the SABIT Program. I understand that returning to my country at the end of the program is a condition of my participation in the SABIT Program. I further understand that traveling outside of the United States (for example, to Canada or Mexico) is strictly prohibited and would be in violation of my U.S. visa and would mean immediate dismissal from the program. Travel to cities in the United States that are not part of the specific SABIT training program is strictly prohibited. This training is sponsored by SABIT therefore all program rules and regulations also pertain to those who already possess a valid U.S. visa.

[Russian, or other language, translation of above paragraph.]

I understand that this program prohibits my spouse and/or children or other family members to accompany SABIT participants to the United States and that friends and family may not stay with me in the hotel room provided by the SABIT Program.

[Russian, or other language, translation of above paragraph.]

I understand that the program will be interpreted into [Russian].

[Russian, or other language, translation of above paragraph.]

If for any reason I must return home early, I understand that I must return the remainder of the stipend to the SABIT Program.

[Russian, or other language, translation of above paragraph.]

_____________________ _____________________

(Date/Дата) (Signature/Подпись)

_________________________________________________________________________________________________________

A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with an information collection subject to the requirements of the Paperwork Reduction Act of 1995 unless the information collection has a currently valid OMB Control Number. The approved OMB Control Number for this information collection is 0625-0225. Without this approval, we could not conduct this information collection. Public reporting for this information collection is estimated to be approximately three (3) hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information collection. All responses to this information collection are voluntary. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to the International Trade Administration, SABIT Program at: 1401 Constitution Avenue, NW, HCHB 12030, Washington, DC 20231, Attn: Tracy Rollins, Director, SABIT Program, [email protected].

The SABIT Program follows Department of Commerce policies against discrimination, found at http://www.osec.doc.gov/ocr/EEOPolicy.html