Employee Questionnaire for H1B visa

1. Family Name

2. First Name

3. Middle Name (if applicable)

4. Date of Birth answer must be date like mm/dd/yyyy

5. Place of Birth (City/Province/Country)

Current Home Address

6. Street Address

Current Home Address

7. City

8. State/Province

9. Country

10. Postal Code

11. Current Home Phone Number

Current U.S. Immigration Status

12. Current Immigration Status

Current U.S. Immigration Status

Enter text for question 12 other

13. Date Status Expires answer must be date like mm/dd/yyyy

14. Date of your Last Arrival in the U.S. answer must be date like mm/dd/yyyy

15. Current I-94 Number

16. Highest Degree

17. Major Field of Study for this Degree

18. Year the Degree was Completed

19. Institution Where this Degree was Received

Address of Institution

20. Street Address

Address of Institution

21. City

22. State/Province

23. Country

24. Postal Code

25. Title of Job Offered to you by UIS

26. Non-Technical Description of Your Job:

27. Annual Salary Offered Per Year answer must be numeric

Work Experience - List all jobs you have held during the past 3 years. Also, list any earlier experience that qualifies you for the permanent job opportunity.

Begin with your current position. Include relevant student employment such as assistantships.

28. Attach a List. Include the Following information for each position: Name of Employer; Address; Type of Business (e.g. University); Type of Employer (e.g. University); Job Title; Start & End Date (Month/Day/Year); Hours per week; Duties Performed (maximum file size: 15MB)

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ALIEN DECLARATION:

The information you have provided on this questionnaire will be submitted electronically to the Department of Labor in Sections J and K of Form ETA 9089 with your name and the following (Section H of the ETA 9089 describes your permanent job offer.) Please read it.

After the labor certification is approved, you will sign this statement on the paper copy which is submitted to USCIS.

29. ⁬I agree with this statement

29. ⁬I agree with this statement

ALIEN DECLARATION:

After the labor certification is approved, you will sign this statement on the paper copy which is submitted to USCIS.

Yes

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