Form H-1b - Request Form - Part A
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3H-1B REQUEST FORM – PART A (To Be Completed by WSU Employing Department)
A. GENERAL AND POSITION INFORMATION
Hiring Department:______________________________College/Division:________________________________
Name of foreign national: ___________________________________________________________________________
Last name
First name
Middle name
Position Title: ___________________________________ Banner ID (if applicable): __________________
Please check:
New H-1B
Extension w/o changes
New Concurrent employment
Extension of Concurrent Employment
Change of employer (non-WSU to WSU)
Amendment (including transfer w/WSU) – explain: ________________________________________
New Concurrent employment with UPG full-time _____ part-time____
Other: ___________________________________________________________________________
Will the employee mentioned above work only for Wayne State University?
Yes
No (attach the other H-1B receipts or approval notices, LCA & Offer Letter )
Explanation: ______________________________________________________________
Will the employee be able to produce a Wayne State paycheck for the wage that will be certified for this petition if that information is
requested by USCIS?
Yes
No
If No, please attach an explanation
The position is (check all that apply):
Temp
Permanent
Tenure Track
Non-Tenure Track
Union Representation (if applicable):
AAUP
P & A
Other: ______________________
The position is:
Full time: Salary Offered $_______________ (specify if 9-month)
# of hours per week ________
Part time: Hourly rate offered $__________ AND Annual salary offered: $____________
# of hours per week ____________
(If there will be any period, such as WSU Holiday Closure, when he/she will not get paid, put a range of hours starting
with “zero,” such as “0 to 30 hours per week”)
* In the case of part-time H-1B petitions, the hiring department, not the H-1B employee, MUST document in
writing the number of hours per day & per week the H-1B employee worked for the entire duration of the part-
time H-1B validity period.
Duration of employment (as appears on the letter of offer): from _________________
to ________________
Hourly Work Schedule: _________________________ i.e. (Monday – Friday 8:30 a.m. – 5:00 p.m.)
Will travel be required to perform the job duties?
Yes
No
If yes, explain the travel requirements:____________________________________________________________________
__________________________________________________________________________________________________
Does compensation package include fringe benefit?
Yes, value of benefits $
No
Place of Employment Information:
Address where the foreign national will work:
______________________________________________________________________________________
Street
City
State
Zip Code
Will work be performed in multiple worksites within an area of intended employment or location (s) other than the address listed above?
Yes
No
If yes, identify the geographic place(s) of employment with as much specificity as possible:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
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Parent category: Business