Information about U.S. company (Petitioner / Employer)

Company or Organization Name

Name and Title of Person authorized to sign forms to be submitted

Full company address

Address where documentation is kept, if different than above

IRS Tax Number

Phone Number

Fax Number

Email

Type of Business

Year established

Current number of employees

Gross annual income in U.S. $

Net annual income in U.S. $

Information about the person you are filing for (Beneficiary / Employee)

Last Name

First Name

Date of Birth

Country of birth

Country of citizenship

Social Security Number (if any)

Alien Number (if any)

Is beneficiary in the U.S.?

Yes No

Date of last arrival (if beneficiary is in U.S.)

Current Immigrant status (if beneficiary is in U.S.)

Expiration date of status (MM/DD/YYYY)

Full U.S. address

Full foreign address

U.S. Consulate closest to foreign address

Does beneficiary have spouse / children?

Yes No

If yes, give names, ages and current status

Has beneficiary been in any H status before?

Yes No

If so, please list the employer(s) and dates of employment

List all previous periods of stay in the U.S. in any H classification for spouse / dependents (if applicable)

Describe beneficiary's present occupation and prior work experience

Beneficiary's complete education background since high school (list names of institutions, dates of attendance and degrees)

Employment information for Job in the U.S.

Job title

Paragraph description of proposed duties

Address where work will be performed in the U.S.

Is this a full time position?

Yes No

If not, please indicate hours per week

Wages per year in U.S.$

Other compensation (please explain and provide value per year in U.S.$)

Anticipated dates of employment in U.S., from (MM/DD/YYYY) to (MM/DD/YYY)

Number of employees beneficiary will supervise (if any)

Daily hours of proposed job

The appropriate basis of the employment in the U.S. is

New employment Continuation of approved employment Change in previously approved employment New concurrent employment

Indicate visa processing for the beneficiary

Beneficiary will process at U.S. Consulate Beneficiary will process in the U.S.

Does the beneficiary have a valid passport?

Yes No

Is the beneficiary in deportation, exclusion or withdrawal proceedings?

Yes No

Has any person in this petition ever filed an immigrant petition?

Yes No