H-1B Questionnaire

PLEASE ANSWER THE FOLLOWING QUESTIONS COMPLETELY

PART A. Information about the Applicant (alien for H-1B status)

1. Family Given Middle

Name___________________ Name___________________ Initial_____________________

Or, if an entertainment group, give the group name:__________________________________

2. Date of Birth Country

month/day/year ______/______/______ of Birth:________________________________

3. Social Security # USCIS “A” number #

(if any) ______/______/______ (if any)_________________________________

4. If in the United States, complete the following:

a. Date of Arrival b. I-94 number___________________________

month/day/year ______/______/______

c. Current Nonimmigrant d. Expires

Status _______________________ month/day/year________________________

e. Current address:_____________________________________________________________

___________________________________________________________________________

5. Address Abroad:______________________________________________________________

___________________________________________________________________________

6. Passport Info: Country: _________________ Number:________________________________

Date Issued:___________________________ Expires:________________________________

7. Describe the proposed duties:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

8. Alien’s present occupation and summary of prior work experience (or attach resume)________

_____________________________________________________________________________

_____________________________________________________________________________

9. Alien’s highest level of education (please indicate if alien has a master’s degree or higher from a U.S. university):

_____________________________________________________________________________

PART B. Information about the Employer

1. If an individual:

Family Given Middle

Name___________________ Name___________________ Initial_____________________

If an organization or company:

Organization/Company Name:______________________________________________________

2. Address: Attn.:_______________________________________________________________

Street number:_______________________________________________________________

City: ____________ State: _____________ Country___________ Zip:___________________

3. IRS Tax #: _____________________

4. Name and title of person signing forms on behalf of the company:_________________________

5. Type of business:_____________________________________________________________

6. Year established:______________________________________________________________

7. Current number of employees:___________________________________________________

8. Gross annual income:__________________________________________________________

9. Net annual income: ___________________________________________________________

10. Total number of full-time employees (or equivalent) working in the United States, including subsidiaries or affiliates:

11. Has employer ever been determined to be a “willful violator” by U.S. Department of Labor of the H-1B labor condition application regulations? qYes qNo

12. Current number of H-1B workers employed by the company:___________________________

PART C. Basic information about the Proposed Employment

1. Job Title: ___________________________________________________________________
2. Minimum Education Requirement:________________________________________________
3. Minimum Experience Requirement:_______________________________________________
4. Special Requirements:__________________________________________________________
5. Address where the person(s) will work if different from above:___________________________

______________________________________________________________________________

6. Is this a full-time position? qYes qNo

If no, give number of hours per week:_________________________________________________

7. Wages: $___________________ per week __________ per year _______________________
8. Other compensation: Value per week: $____________________________________________

Explain:_______________________________________________________________________

9. Dates of intended employment: From ____/____/____ to ____/____/____
10. Job Title of Alien’s Supervisor:___________________________________________________
11. Number of Workers Alien Will Supervise:___________________________________________

Part D: Spouse and Children

Does the applicant have a spouse or unmarried children under 21 years of age who are now in the U.S. and will be changing status? qYes qNo

If yes, answer the following about each member of the family:

1. Full name:________________________________________________________________

2. Date of birth:_____________________________________________________________

3. Country of birth:__________________________________________________________

4. Social Security # (if any): ______________________ A# (if any):____________________

5. I-94# ___________________________

6. Current Nonimmigrant status _____________ Expires on (month/day/year):____________

7. Passport Country of issuance: ____________________ Valid to: _____________________

8. Foreign Address: __________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

NOTE: WE WILL NEED A COPY OF EACH DEPENDENT’S I-94.