H-1B PETITION EMPLOYEE QUESTIONNAIRE SUPPORTING DOCUMENTS CHECKLIST Please email the fllwing dcuments t Office f Internatinal Prgrams as scanned clr cpies. Cmpleted H-1B Emplyee Questinnaire Please als review the H-1B Visa General Infrmatin dcument. I-140 Receipt and/r Apprval Ntice, if applicable (I-140 is the petitin fr emplyment based permanent residency) Passprt identificatin pages I-485 Receipt Ntice, if applicable (I-485 is the petitin t adjust status t permanent residency) U.S. visa stamps affixed in passprt Any receipt ntices r apprval ntices related t applicatins fr U.S. permanent residency, if applicable U.S. Custms and Brder Prtectin arrival date stamps in Driver s license passprt I-94 (can be btained nline at https://i94.cbp.dhs.gv/i94/#/hme) CV r resume Current status dcument: All degree certificates earned: F-1/F-2 Status: Mst recent I-20 dcuments EAD card, if applicable J-1/J-2 Status: Mst recent DS-2019 H-1B Status: Mst recent H-1B/I-797A apprval ntice If yur degree was earned utside f the United States, please include a cpy f a credentials evaluatin reprt r degree equivalency reprt btained thrugh a U.S. evaluatin service If yu currently d nt have a credentials evaluatin reprt, please request a reprt frm either FCSA (www.freigncredentials.rg) r anther U.S. evaluatin service prvide If degree certificates are nt in English, please include cpies f certified English translatins. Previus status dcuments: All transcripts fr degrees earned: F-1/F-2 Status: All previus I-20 dcuments All previus EAD cards, if applicable If transcripts are nt in English, please include cpies f certified English translatins. J-1/J-2 Status: All previus DS-2019 dcuments H-1B Status: All previus H-1B/I-797A apprval ntices 3 mst recent paystubs (if currently emplyed in the United States) Prfessinal licenses, if applicable I-612 Waiver Apprval Ntice (if subject t 212 (e), tw year hme stay Bard certificatin, if applicable requirement, while n J-1/J-2 visa) U.S. Department f State Favrable Recmmendatin Letter (if ECFMG certificatin, if applicable subject t 212 (e), tw year hme stay requirement, while n J-1/J-2 visa) If yu have dependents wh will need H-4 visa status, please prvide the fllwing dcuments r fllw these instructins. Dependents currently in the United States Dependents currently utside f the United States Cmpleted I-539 Applicatin (https://www.uscis.gv/i-539) Please nte OIP will need t receive the riginal applicatin frm. Signatures shuld be in blue ink. Mailing address in Part 1 shuld be the fllwing: Dependents will have t apply fr H-4 visas directly at a U.S. Cnsulate/Embassy clsest t their place f residence. Please visit: www.usembassy.gv fr mre infrmatin and ntify OIP. General prcess includes: Cmpleting Online Nnimmigrant Visa Applicatin, Frm DS-160 3901 Rainbw Blvd., Mail Stp 3033 Kansas City, KS 66160 Be prepared t uplad a pht I-539 filing fee f $370 (check made payable t U.S. Department f Hmeland Security) Passprt identificatin pages fr all dependents I-94 dcuments fr all dependents (can be btained nline at https://i94.cbp.dhs.gv/i94/#/hme) Visa stamps fr all dependents All current and previus status dcuments fr all dependents (i.e. I-797 Apprval Ntice, DS-2019, I-20, etc.) Cpy f marriage certificate (if nt in English, please include a cpy f a certified English translatin) Cpy f children s birth certificates (if nt in English, please include a cpy f a certified English translatin) Letter frm H-1B applicant cnfirming his/her ability t prvide financial supprt fr dependents (include prf f financial supprt i.e. pay stubs) Scheduling a visa interview Paying $190 applicatin fee Preparing the fllwing dcuments, but it is nt limited t this list, please check with U.S. Cnsulate: Valid passprt Nnimmigrant Visa Applicatin, Frm DS-160 cnfirmatin page. Applicatin fee payment receipt, Cpy f H-1B apprval ntice Prf f H-1B emplyment (i.e. ffer letter r paystubs) Prf f relatinship (i.e. marriage certificate r birth certificate) Dcuments must be in English r a certified English translatin Generally need t shw prf f cmpelling ties t yur hme cuntry Page 1
CONTACT INFORMATION If yu have any questins related t yur H-1B petitin r the H-1B prcess, please d nt hesitate t cntact Kimberly Cnnelly and Irina Aris. Please be sure t include bth Kimberly Cnnelly and Irina Aris in any cmmunicatin sent by email. Kimberly Cnnelly Hlland, M.A.T. Senir Internatinal Officer, PDSO, ARO Email: kcnnelly@kumc.edu Phne: (913) 588-1480 Irina Aris, M.P.A. Assistant Directr f Inbund Prgrams, RO, DSO Email: iaris@kumc.edu Phne: (913) 588-1485 Office f Internatinal Prgrams University f Kansas Medical Center 3901 Rainbw Blvd., MS 3033 5010 Wesce Kansas City, KS 66160 Email: InternatinalPrgs@kumc.edu Phne: (913) 588-1480 Fax: (913) 588-1462 REQUEST FOR PREMIUM PROCESSING (OPTIONAL) Please cmplete this frm if yu as the prspective H-1B emplyee wuld like t request premium prcessing f yur petitin. Attach this frm with the H-1B Emplyee Questinnaire if the request is being made at the time f filing. If yu wuld like yur H-1B case t be cnverted t premium prcessing after filing, please email this frm directly t the Office f Internatinal Prgrams. Family Name (Last Name): Given Name (First Name): Full Middle Name: YES, I wuld like t request premium prcessing and I will enclse a check fr $1225 payable t the U.S. Department f Hmeland Security. Signature Date Page 2
PART 1: EMPLOYEE BIOGRAPHICAL INFORMATION This frm shuld be filled ut by the prspective H-1B emplyee. Please prvide as much infrmatin and detail as pssible. Print legibly r type ut the infrmatin requested belw. Family Name (Last Name): Given Name (First Name): Full Middle Name: All Other Names Used: Date f Birth Cuntry f Birth: Prvince f Birth: City f Birth: Gender: Male Female Scial Security Number (SSN), if any: Alien Registratin Number (A- Number), if any: Current Residential U.S. Address (if applicable): Street Name and Number: Apt. Ste. Flr. Number: City r Twn: State: Zip Cde: Freign Address (required): Street Name and Number: Apt. Ste. Flr. Number: City r Twn: State: Prvince: Pstal Cde: Cuntry: Cntact Infrmatin: Email Address: Hme Phne #: Cell Phne #: Wrk Phne #: PART 2: CURRENT STATUS (IF IN THE UNITED STATES) Date f Last Arrival Current Nnimmigrant Status: Date Status Expires 1. D yu have any upcming internatinal travel plans? YES NO a. If yes, please prvided anticipated travel dates: PART 3: IMMIGRATION HISTORY 1. Have yu ever held F-1/F-2 status? YES NO a. IF YES, please reference the Emplyee Questinnaire Checklist and prvide cpies f all requested dcuments. 2. Have yu ever held J-1/J-2 status? YES NO a. IF YES, please reference the Emplyee Questinnaire Checklist and prvide cpies f all requested dcuments. 3. D yu currently hld H-1B status nw and/r have yu ever previusly held H-1B status? YES NO a. IF YES, please reference the Emplyee Questinnaire Checklist and prvide cpies f all requested dcuments. b. IF YES and yu are interested in recapturing time spent utside the United States tward yur 6-year maximum duratin f stay, please cmplete Recapture Time Wrksheet r Part 8 f this questinnaire. 4. Have yu ever held any ther visa status in the United States nt listed in questins 1-3 abve? YES NO a. If YES, please prvide visa status type and dates as well as prvide cpies f any related dcuments: Page 3
5. Have any f the fllwing immigrant petitins been filed n yur behalf r in the prcess f being filed? a. Emplyment Based Permanent Residency Petitin YES NO EB-1 (sub-categries: Extrardinary Ability, Outstanding Prfessrs and Researchers, Multinatinal Manager r Executive); EB-2(sub-categries (must have Labr Certificatin): Advanced Degree, Exceptinal Ability, Natinal Interest Waiver (NIW)); EB-3 (sub-categries (must have Labr Certificatin): Skilled Wrkers, Prfessinals, Unskilled Wrkers (Other Wrkers)) b. Other Type f Permanent Residency Petitin YES NO i.e. family r spuse based. i. If YES, please prvide related dcuments and the fllwing infrmatin: Infrmatin abut attrney wh is filing r wh had filed a Permanent Residency Petitin n yur behalf Name f Attrney: Name f Law Firm: Phne Number: Email Address: 6. Have yu/yur family members always maintained yur visa status in the United States? YES NO a. IF NO, please prvide full details regarding any perid where yu/yur family members were ut f status: 7. Has yur wrk in the United States always been authrized by USCIS? YES NO b. IF NO, please prvide details regarding any unauthrized wrk PART 4: EMPLOYMENT HISTORY 1. List yur current and previus wrk histry. Start Date End Date Psitin Title Emplyer Place f Emplyment (mm/dd/yyyy) (mm/dd/yyyy) (City, State, Cuntry) Visa Status Type (If in the United States, visa status type i.e. F-1 OPT, J-1, etc.) Page 4
PART 6: EDUCATION BACKGROUND 1. List yur educatinal backgrund starting with the highest degree earned. Majr r Field f University/Institutin Study Degree (i.e. Dctral/Ph.D., Master s, etc.) Date Degree Awarded (mm/dd/yyyy) City and Cuntry PLEASE NOTE: If yu received yur degree at an institutin r university utside f the United States, yu will need t btain a credentials evaluatin reprt frm a U.S. evaluatin service prvider. See checklist fr mre infrmatin. PART 7: DEPENDENTS/FAMILY MEMBERS 1. What is yur marital status? SINGLE MARRIED 2. D yu have any children? YES NO 3. D yu have dependent family members (spuse/children) wh will need H-4 status? YES NO a. IF YES, please reference the Emplyee Questinnaire Checklist and prvide cpies f all requested dcuments. PLEASE NOTE: while yur emplyer pays fr the cst f yur H-1B petitin, the emplyer is nt required t cver the filing fees related t yur dependents H-4 status petitin. If H-4 status is needed fr family members, please see checklist and prvide t OIP the requested dcuments. A check fr the $290 filing fee shuld be included with the dcuments. The check r mney rder shuld be made payable t the U.S. Department f Hmeland Security. One I-539/H-4 applicatin cvers all dependent family members. PART 8: RECAPTURE TIME WORKSHEET If yu are extending yur H-1B r changing H-1B emplyers and wuld like t RECAPTURE time nt spent in the United States tward yur 6-year maximum perid f stay, please list H presence dates r internatinal travel dates fr yu and any dependent H-4 family members fr all trips yu ve made utside f the United States since yu were first granted H status. Additinally, prvide related prf r evidence dcumenting these dates such as cpies f entry and exit stamps. First Date f H Status Date f Re-Entry t United States Date f Re-Entry t United States Date f Re-Entry t United States Date f Re-Entry t United States Date f First Departure frm the United States Date f Departure frm the United States Date f Departure frm the United States Date f Departure frm the United States Date f Departure frm the United States Page 5
Date f Re-Entry t United States Date f Re-Entry t United States Date f Re-Entry t United States Date f Re-Entry t United States Date f Re-Entry t United States Date f Departure frm the United States Date f Departure frm the United States Date f Departure frm the United States Date f Departure frm the United States Date f Departure frm the United States PART 9: ACKNOWLEDGEMENT ACKNOWLEDGEMENT I attest that the infrmatin prvided in this questinnaire is true and crrect. I have als read and understd infrmatin prvided in the H-1B Visa General Infrmatin dcument. Prspective H-1B Emplyee Signature: Date: Prspective H-1B Emplyee Name: Page 6