Fillable H-1B Petition Request (University of Mississippi Medical Center)

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H-1B Petition Request (University of Mississippi Medical Center)

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The H-1B Petition Request (University of Mississippi Medical Center) form is 2 pages long and contains:

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  • 9 check-boxes
  • 21 other fields

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File type: PDF

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REQUEST FOR H-1B PETITION
Employee’s name (first, middle, last):
Sponsoring department: Name of H-1B sponsor:
Department contact: Proposed UMMC job title:
Number of hours to be worked each week:
Salary (per year) or wage (per hour):
Number of people this person will supervise:
Dates of intended employment:
From:
To:
Provide a summary of the H-1B workers’s proposed/current duties and responsibilities. Please enter
actual day-to-day duties and responsibilities rather than a generic description. Example: for researchers
include a detailed description of the reasearch performed, specific laboratory techniques utilized, etc.
Please check one:
Initial H-1B petition
Extension of current H-1B authorization - no change in employment since filing of last petition
Extension of current H-1B authorization - nominal change in employement (title, duties, salary, etc.)
since filing of last petition
Amended petition - substantial change in employment (title, duties, salary, etc.)
Change in H-1B employer sponsorship (transfer to UMMC from another organization/institution)
This form must be completed by the department sponsoring the prospective H-1B employee. It must be signed by
both the faculty sponsor and department chairman/head. Please return this form together with the H-1B Applicant
Information Form to the Office of International Services.
Title(s) of position(s) to be supervised:
List the names and addresses of all sites (other than the main UMMC campus at 2500 North State
Street) where this individual will perform work as a UMMC employee:
I certify to the best of my knowledge that the above information is true and correct:
____________________________
Signature of H-1B Sponsor Date
____________________________
Signature of Department Chairman
Date
Minimum education, training and experience requirements for this position as stated on the official
UMMC job description:
____________________________
Signature of Department Business
Administrator
Date
Minimum edcational requirement (degree and field):
Is prior employment experience required for this position? Yes No
If yes, enter the minimum number of months of experience required
In what ocupation(s) would one normally be employed to acquire this experience?
If yes, enter the minimum number of months of training required
In what specific field(s) would this training normally be acquired?
Is training required for this position? Yes No
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H-1B Petition Request (University of Mississippi Medical Center)

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Completed 25 July 2020

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