Form H-1b - Employee Information Form - 2012
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3H-1B EMPLOYEE INFORMATION FORM
Please complete this form and return it to your sponsoring faculty member or the contact person
in your department with all required supporting documents listed on the checklist. With questions
related to this form, please contact Elizabeth Adamska at adamska@unr.edu, or call us (775)784-6874.
A. Personal
Last Name ______________________First Name _________________Middle Name ________
Date of Birth ___/ ___ / ___ Country of Birth _________________ Province ____________
mm dd
yr
Country of Citizenship ___________________U.S. Soc. Sec. #
_________________
(if available)
Foreign Address ________________________________________________________________
U.S. Home Address
____________________________________________________
(if available)
Home Phone # ________________ Work Phone # _______________ E-mail _______________
Highest Degree Obtained (Please check only one box):
[ ] Bachelor’s degree
[ ] Master’s degree
(i.e. BA, AB, BS)
(i.e: MA, MS, MEng. MEd, MSW, MSB)
[ ] Professional degree (
)
[ ] Doctorate degree
)
i.e. MD, DDS, DVM, LLB, JD
(PhD, EdD
Month & Year ______________ Institution _________________________________________
Major/Primary Field of Study: _____________________________________________________
Gender: ______ Male _____ Female
Marital Status: _____ Married _____ Single
B. Current Immigration Status (complete this section only if you are now in the U.S.)
Initial Arrival Date ___/___/____
Most Recent Arrival Date ___/___/___
mm dd
yr
mm dd yr
Current Status: F-1 __F-2 __J-1 __J-2 __H-1B __H-4 __TN __
Other (specify) ________
I-94# ________________________ Expiration Date of your current status: _____/_____/_____
mm
dd
yr
Do you have any plans to travel outside of the U.S. between now and the start date of your
petition? Yes ____No ____ If yes, please list dates of travel __________________________
_____________________________________________________________________________
and contact OISS to discuss your travel and its possible impact on the pending petition.
Page 1 of 3 | 12/2012
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Parent category: Business