Fillable Form H-1b - Employee Information Form

Form H-1b - Employee Information Form - 2012 Page 2

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C. Other Immigration Information

Specify the location of U.S. Embassy/Consulate where you will apply for your entry visa if you are

currently overseas, or in case your change of status is denied __________________________

Have you ever been in J-1 status? Yes _____ No _____

If yes, are you subject to the 2-year home residence requirement (212e): Yes _____ No _____

If yes, have you fulfilled this requirement or obtained a waiver: Yes _____ No _____

If you are still subject to 212e, you are not eligible for H-1B status.

Have you been granted H or L status in the past? Yes _____ No _____ If yes, please indicate

the period of time you were approved for H or L status: _____________________________

Have you been absent from the US during any time that you were approved for H or L status?

Yes ____ No ____ If yes, list dates and circumstances: _______________________________

______________________________________________________________________________

Have you ever filed for permanent residency? Yes _____ No _____ If yes, provide additional

information about your case: when, type of petition, case # ______________________________

______________________________________________________________________________

Are you in exclusion or deportation proceedings? Yes _____ No _____

C. Family Information

[ ] I do not have dependents in the U.S.

[ ] My dependents do not require H-4 status.

[ ] I do have ___ (number) dependents who require H-4 status.

If dependents (spouse and/or children) are currently in the US, please download Form I-539 from

The form must be completed by the dependent(s), not H-1B employee! Also

submit documents listed on the checklist in section C.

Please list your dependents:

____________________________________________________________________________________

______________________________________________________

Page 2 of 3 | 12/2012

Form H-1b - Employee Information Form - 2012 Page 2

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