H1B Application Form

* = Required Information

Do you have a dependent for which you would like to apply H-4:

Yes

Name given as in the Passport

Last Name: *

Given Name: *

Middle Name: *

Birth Date: *

Gender:

Male

Female

Country of Birth: *

Country of Citizenship: *

Place of Birth:

City:

State:

Social Security #:

Cell #:

Work #:

Email: *

Work Email:

CURRENT U.S. ADDRESS

Street Name:

Apt Number:

City:

State:

Zip Code:

U.S. ENTRY INFORMATION

Date of Initial Entry:

Date of Last Entry:

Place of last Entry to the U.S.:

Status at entry:

Choose an item

Current Status:

Choose an item. Arrival/Departure (I-94):

Date authorized stay expires:

Passport Number:

Country of Issue:

Date Issued:

Expiry Date:

List all periods you have been on H1B

Click here to enter a date

List all periods you have been on H4

Click here to enter a date

List all periods you have been on L1

Click here to enter a date

EDUCATION HISTORY

Highest Level of Education:

Date Degree Completed:

Name of University:

Degree Awarded(Major/Discipline):

Address:

Other Education:

Date Degree Completed:

Degree Awarded(Major/Discipline):

Date Degree Completed:

Name of University:

INFORMATION ABOUT THE CURRENT H1B STATUS

Is this a New H1-B

Extension with the same employer

Transfer to a new employer

If this is an extension - This is the FIRST

or SECOND/SUBSEQUENT

extension

In total how long have you been on H1-B Status?

Years:

Months:

Do you have an approved I-140 petition?

yes

PROSPECTIVE EMPLOYER INFORMATION

Full legal name of the prospective employer:

Doing Business As (DBA) name if any:

Company address:

City:

Houston State:

TX Zip County:

Telephone Number:

Fax Number:

Web Address:

Company Tax ID #:

Name of Company Contact

Title:

Email Address:

Tel. Number:

Name of company official who will sign the petition:

Title of company official who will sign the petition:

Email address of signatory:

Tel. Number:

INFORMATION ABOUT THE JOB OFFER

Work address where the job is performed if different to above:

City:

Houston State:

Zip:

County:

Job Title:

Wage Offered:

Start Date:

Educational Requirement:

Licensure Requirement:

Job Duties:

SPOUSE/CHILDREN INFORMATION

(ONLY IF APPLYING FOR H4 OR TD)

Spouse’s given as in the Passport

Last Name:

Given Name:

Middle Name:

Birth Date:

Gender:

Male

Female

Country of Birth:

Country of Citizenship:

Place of Birth:

City:

State:

Social Security #:

Cell #:

Work #:

CURRENT U.S. ADDRESS

Street Name:

State:

City:

Country:

U.S. ENTRY INFORMATION

Date of Initial Entry:

Date of Last Entry:

Place of last Entry to the U.S.:

Status at entry:

Choose an item

Current Status:

Choose an item. Arrival/Departure (I-94):

Date authorized stay expires:

Passport Number:

Country of Issue:

Date Issued:

Expiry Date:

List all periods you have been on H1B

Click here to enter a date

List all periods you have been on H4

Click here to enter a date

List all periods you have been on L1

Click here to enter a date

Child’s given as in the Passport

Last Name:

Given Name:

Middle Name:

Birth Date:

Gender:

Male

Female

Country of Birth:

Country of Citizenship:

Place of Birth:

City:

State:

Social Security #:

Cell #:

Work #:

CURRENT U.S. ADDRESS

Street Name:

Apt Number:

City:

Zip Code:

U.S. ENTRY INFORMATION

Date of Initial Entry:

Date of Last Entry:

Place of last Entry to the U.S.:

Status at entry:

Choose an item

Current Status:

Choose an item. Arrival/Departure (I-94):

Date authorized stay expires:

Passport Number:

Country of Issue:

Date Issued:

Expiry Date:

List all periods you have been on H1B

Click here to enter a date

List all periods you have been on H4

Click here to enter a date

List all periods you have been on L1

Click here to enter a date

Please Provide the Following documents:

Educational documents - All degree certificates & transcripts Current Visa papers - (I-20s /OPT Card/I-797) Current I-94 & Passport copies 3 Latest Pay stubs (only if applying for H1-B extension or transfer) Current Contract/ Offer Letter from previous employer Current TX Licensure and registration certificate Full report from Comprehensive Credentials Review (Type I Certificate) OR Visa Credentials Certification (Type II Certificate) from FCCPT Marriage certificate (only if applying for H4 with H1 petition) Spouse’s/Children’s I-94 and passport copy (if applying for H4) Spouse's/Children’s H4 approval Form I-797 (if any)