Fillable H1BEmployee Student Information Form

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H1BEmployee Student Information Form

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Office of International Students & Scholars
H-1B Request
(Completed by H-1B Worker)
oiss@stthomas.edu, Tel: 651-962-6650, Fax: 651-962-6655
H-1B Request Form
Please complete this form and return it to your department with all required supporting documents. Please see the
checklist for more information regarding the additional documents required for this petition.
Personal Information:
Name (Surname, First, Middle as in your passport):
All Other Names Used (maiden name, aliases, etc.):
Date of Birth (mm/dd/yyyy):
Gender:
Email Address:
Phone:
U.S. Social Security Number (if applicable): ________ - _______ - _________
A# (usually J-2s with an EAD, F-1’s on OPT, or those with pending permanent residency applications):
Country & Province of Birth:
Country of Citizenship:
Your Foreign Address (required):
If currently in the U.S. please fill out below section. Otherwise skip to the next section.
Date of Most Recent Arrival (mm/dd/yyyy):
I-94#:
Current Non-Immigrant Status:
Expiration Date of Current Status (mm/dd/yyyy):
Current U.S. Address:
Passport Number:
Date Passport Issued:
Passport Expiration Date:
Do you have any plans to travel outside the U.S. in the next six months? ) Yes No
I
f yes, please list dates of travel: From:__________________ To:_________________________
Please complete this section in case you need to obtain a visa or the change of status is denied.
Location of U.S. Consulate or Inspection Facility:
Type of Office: Consulate Pre-flight inspection (Canadians only) Port of Entry (Canadians only)
U.S. State or Foreign Country:
Office of International Students & Scholars
H-1B Request
(Completed by H-1B Worker)
oiss@stthomas.edu, Tel: 651-962-6650, Fax: 651-962-6655
Do you have dependents? Yes No
Only a spouse and unmarried children under age 21 can be considered dependents.
If yes, please list all of your dependents:
Name of Dependent as it
Appears on Passport:
Age:
Relationship to You:
Current Status (if in the
U.S.):
Will this Dependent
need an H-4?
Yes or No
H
ave you or your dependents ever been denied an immigration benefit? Yes No
If yes, explain on a separate sheet of paper.
Do you have any criminal history? Yes No
If yes, explain on a separate sheet of paper.
Are you or any dependents in exclusion of deportation hearings? Yes No
Petition Information:
Previous H-1B Status?
Have you ever been granted H-1B status? Yes No
If yes, please list all periods of stay in H status for the last 6 years.
List
only
those dates in which you were actually in the U.S. in H-1B classification:
H-1B From:__________________ To:_________________________
H-1B From:__________________ To:_________________________
H-1B From:__________________ To:_________________________
H-1B From:__________________ To:_________________________
H-1B From:__________________ To:_________________________
Have you ever been denied H-1B status? Yes No
Current H-1B Employer:
If currently in H-1B status, provide name of current employer if other than the University of St. Thomas:
Expected last day of employment with this employer:
Office of International Students & Scholars
H-1B Request
(Completed by H-1B Worker)
oiss@stthomas.edu, Tel: 651-962-6650, Fax: 651-962-6655
Previous F Status:
SEVIS Number: _________________________________ OPT Card Number: ________________________________
Employment Authorization (OPT/STEM OPT) Dates: From:__________________ To:_________________________
Previous J-1/ J-2 Status?
Have you ever been granted J-1 or J-2 status in the U.S.? Yes No
If you answered yes to the above question please choose one of the following and attach copies of all
DS-2019s and waiver letters, if applicable:
□ I have been in J-1 or J-2 status in the U.S., but have never been subject to 212(e)
□ I am subject to 212(e) but a waiver request is currently pending
□ I was subject to 212(e) but have a U.S. State Department waiver recommendation letter
□ I was subject to 212(e) but have a waiver approval notice from USCIS
□ I was subject to 212(e) but spent two years in my home country
□ I am subject to 212(e) but have not applied for a waiver
List below all time spent in J-1 or J-2 status:
J-1
or J-2 From:__________________ To:_________________________
J-1 or J-2 From:__________________ To:_________________________
J-1 or J-2 From:__________________ To:_________________________
J-1 or J-2 From:__________________ To:_________________________
J-1 or J-2 From:__________________ To:_________________________
Permanent Residency/ Exclusion?
Has anyone ever submitted an immigrant (permanent residency) Yes No
petition for you or your dependents?
If yes, has Labor Certification been submitted? Yes No
Has an I-140 been filed? Yes No
Do you have a pending I-485 application to adjust status? Yes No
Do you plan to apply for Permanent Residency? Yes No
Office of International Students & Scholars
H-1B Request
(Completed by H-1B Worker)
oiss@stthomas.edu, Tel: 651-962-6650, Fax: 651-962-6655
Academic:
Highest Academic Degree Earned:
Name of University that granted the degree:
I
f not from an institution in the U.S., you will need to include an Education Credentials Evaluation.
Major Field of Study:
H-1 Conditions Acceptance:
I understand that:
- An individual in H-1B status may not receive payment from any source other than the St. Thomas
department that sponsored the H-1 status or another H-1 concurrent sponsor except
reimbursement for travel expenses for lecturing.
- If my St. Thomas employment ends, my H-1 petition becomes invalid.
- Any changes in employment, change in time, title, salary, responsibility, etc. may require a new
H-1 petition to be filed with USCIS and I must contact OISS immediately.
- If I am dismissed from employment before the end date of my H-1 status, St. Thomas i
s
r
esponsible for paying the reasonable costs of return transportation to my last place of foreign
residence.
- The hiring department is required to notify OISS when I terminate employment with St. Thomas.
A
ll of the above information on these forms is complete and accurate.
P
rint Name________________________________________________________________________________________
S
iganture__________________________________________________________ Date__________________________
Office of International Students & Scholars
H-1B Request
(Completed by H-1B Worker)
oiss@stthomas.edu, Tel: 651-962-6650, Fax: 651-962-6655
H-1B Worker Checklist
Please submit one copy (no staples) of the items below to OISS:
All applicants:
□ Copy of diploma AND English translation, if applicable
□ Copy of official transcript (plus English translation, if applicable) A credential evaluation is
required if degree is from a non-U.S. institution.
□ Current resume/ CV
□ Unaltered original document form and translation form, if applicable
□ Passport identity page and expiration page
If currently in the U.S., also provide:
□ I-94
□ Entry visa
If applied for Permanent Residency:
□ Copies of all notices received from USCIS
If ever in F-1 or F-2 status:
□ Copies of all previous I-20’s
□ Copies of all previous EAD’s, if applicable
□ If on OPT, copies of all paystubs and list of employers worked while on OPT
If ever in J-1 or J-2 status:
□ Copies of all previous DS-2019s/IAP-66s
□ Copy of 212(e)/Two Year Home Residency waiver, if applicable
If in H-1 or H-4 status:
□ Copies of all previous I-797 Approval Notices
□ Copies of all H-1’s last four months of paystubs
Dependent information (for those applying inside the U.S. only):
□ Form I-539 completed by the dependent
□ Proof of dependent relationship to H-1B applicant (marriage/birth certificate and English
translation)
□ Copy of dependents’ I-94
□ Copy of dependents’ entry visa
□ Copy of dependents’ passport identity page and expiration page
□ Evidence of current non-immigrant status
□ Evidence of financial support
□ Petition fee for I-539 (check or money order in U.S. dollars payable to Department of
Homeland Security)
Unaltered Original Documents
Translation of Foreign Language Documents
H1-B Request Form by Employee 2018.docx
To the United States Citizenship and Immigration Services
Copies of documents submitted are exact copies of unaltered original
documents. I understand that I may be required to submit original documents
to an immigration or consular official at a later date.
______________________________________
Print Name of H-1B Worker
______________________________________
Signature of H-1B Worker
______________________________________
Date Signed
I,______________________________ hereby certify that I am competent to translate
from the ________________________ language into English and that the attached is
the accurate translation of the original document.
______________________________________
Print Name & Title of Translator
______________________________________
Signature of H-1B Worker
______________________________________
Date Signed
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H1BEmployee Student Information Form

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Completed 18 November 2019

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