Email Address  (required)


Employer:


	

		
Name Of Organization 

		
Name Of Person To Whom Notice Is To Be Sent
 
		
Address, Telephone Number, and Fax Number 

		
United States Internal Revenue Service (IRS) Tax Number 

		
Does your work force consist of 15% or more of H-1B visa holders? 

	


	
Information About The Alien:


	

		
Name 

		
Date Of Birth
 
		
Country Of Birth 

		
Social Security Number (if any)
 
		
Present Occupation & Employment History 

		
Alien's Academic Background Including Names, Dates,
Degrees and Previous Employment 

		
Alien's Address Outside The United States 

	


	
Information About Employer & Employment:


	

		
Job Title Alien Will Have 

		
Nontechnical Description Of Job Duties
 
		
Full Description Of Job Duties 

		
NAICS code for job (North American Industry Classification)
(This is for employer's type of business, not individual job) 

		
Address Where The Person Who Will Work, If Different From
Part A-3 

		
Is This A Full-Time Position, if not, How Many Hours Per Week? 

		
Wages To Be Paid To Alien 

		
Dates Of Intended Employment 

		
Type Of Petitioner (organization, ie. corporation, 
partnership, other) 

		
Type Of Business (manufacturer, consultant, etc.) 

		
What Year Was Your Business Established 

		
Current Number Of Employees In Business 

		
If you have up to 25 employees, do you have 8 or more employees who are
 in H-1B status? 

		
If you have 26-50 employees, do you have 1 or more employees who are in
 H-1B status? 

		
The law requires companies to offer benefits to H-1 employees on the same basis as offered to similarly 
employed U.S. workers.  Is this being done at your company? 

		
Gross Sales 

		
Name Of Person Signing Petition 

		
Title of Person Signing 

		
What is the time of daily employment? 

		
What is title of immediate supervisor? 

		
What are requirements for job (such as level of degree, type ofdegree,
 any particular courses, any length and special type of experience)? 

	


	
If Alien Is Outside Of The United States:


	

		
Which Consul Will The Approval Be Sent To? 

	


	
If Alien Is In The United States:


	

		
Date of Arrival 

		
1-94 Number 

		
Current Nonimmigrant Status 

		
Expiration Date 

		
Does A Person Have A Valid Passport? 

		
Is The Person Filing Any Other Petitions With This One, Or Is An Application
 For Replacement Of I-94 Being Filed With This Petition? 

		
Are Applications Of Dependents Being Filed With This
Petition? 

		

			
If so, how many? 

		
		
Is The Person In This Petition In Exclusion or Deportation
Proceedings? 

		
Have You Ever Filed An Immigrant Visa Petition For The Person In This Petition? 

		
Address In The United States 

		
Home Phone Number 

		
Business Phone Number 

	


	
List all times you entered the U.S., and list the visa status of each entry: