18 Tremont Street
Boston, Massachusetts 02108
Tel : (617) 742-4444
Fax : (617) 742-0805
Eml : Richard@Costariccio.com
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H-1B Applicant Checklist and Worksheet |
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- Please direct specific inquiries and/or
responses to the attention of Melissa Fox-Glassbrenner
(melissaF@rcosta.com)
Senior Paralegal.
- Please consult with us before making any
plans to travel outside the U.S. before, during,
or after the processing of an H-1B or L-1
Petition.
- Your Name: _________________________
- Petitioning Company:
_________________________
- Date: Company HR Contact:
_________________________
- Position: Job Location (City/State)
_______________________
- Current Visa Status: Current
Employer:______________________
- If in H-1B status, are you currently
maintaining employment with your employer?
_______
- Would you like to be added to our email
update list? We periodically send emails to
inform clients of changes in CIS practice and
procedures. ____ Yes ____ No
- Name/title of company official authorized to
sign the H-1B petition (if different from the
human resources
contact)__________________________________________________
- Anticipated Start-date
__________________________________
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PLEASE PROVIDE THE FOLLOWING DOCUMENTS (AS
APPLICABLE)
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- Attached worksheet completed in its entirety
- Copies of both sides of Form I-94 for
yourself and any dependent family members
- Copies of all I-20s issued (for F-1
students) or Forms I-AP66 (for J-1 Exchange
Visitors).
- Copies of first few pages of passport for
yourself and all dependent family members,
including copies of any U.S. visas and
biographical pages.
- Copy of your most recent resume
- Copy of most recent paystub (if currently on
H-1B visa, you will be required to submit a
recent paystub to prove continued employed).PLEASE
CONTINUE TO SEND COPIES OF NEW PAYSTUBS TO OUR
OFFICE UNTIL SUCH TIME AS THE H-1B PETITION IS
FILED WITH THE CIS
- Copies of all educational documents (college
and above), including diplomas (and transcripts
if readily available; if diploma is not readily
available, applicant must provide confirmation
of completion of university degree from an
authorized university or college official). Also
please provide translations for all pertinent
foreign language documents
- Copy of any previously conducted formal
credential evaluation
- Copy of offer letter
- Copies of all previous Approval Notices
(I-797 or I-171C), including Optional Practical
Training Card
- Copies of previous H-1B support letters (if
available)
- Copies of any correspondence from the CIS,
State Department, Labor Department, or U.S.
Information Agency.
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PLEASE ANSWER THE FOLLOWING QUESTIONS:
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- Please list your legal name:
Last/Family Name: _________________________
First/Given Name: _________________________
Other names used: _________________________
- Present home address:
_________________________
_________________________
_________________________
Telephone (home): _________________________
Telephone (work): _________________________
FAX: Pager/Beeper: _________________________
Email: _________________________
- Address abroad to which you will return (Required:
please do not leave blank):
Street # and Name:
________________________________________________
Apt. # (if applicable)
_______________________________________________
City or Town:
_____________________________________________________
State or Province:
_________________________________________________
Country:
_________________________________________________________
Zip or Postal Code:
________________________________________________
- Date of Birth: _________________________
- City and Country of Birth:
_________________________
Present Nationality or Citizenship:
_________________________
- Country of Passport Issuance:
_________________________
Passport Issue Date:____________
Passport Expiration date: __________________
Passport Number: _______________
- Present Occupation (title):
_________________________
- U.S. Social Security Number (if any):
_________________________
- Please list dates of any prior visits to the
U.S. and visa status used. (If B-1 or B-2
visitor status only, specific dates are not
required; a statement such as “several short
visits between 1985 and 1993 - not more than
three weeks at one time” is sufficient --for any
other status, please be specific)
Entered: Departed: Status:
_________________________
Entered: Departed: Status:
_________________________
(please continue on separate sheet, if
necessary)
- Have you ever applied for an Immigrant Visa
or Permanent Residence in the U.S.? _____
If so, where? _________________________
- Has any visa petition filed on your behalf
been denied? _______________
- Have you ever been in deportation or
exclusion proceedings? _____________
- Have you ever held a J-1 Visa? ___ Yes ___
No
If yes, were you subject to the 212(e)
regulation requiring a waiver of the two-year
foreign residency requirement?
___ Yes ___ No
Has your spouse (if applicable) ever held a J-1
Visa? ___ Yes ___ No
If yes, was your spouse subject to the 212(e)
regulation requiring a waiver of the two-year
foreign residency requirement?
___ Yes ___ No
- Are you from a country that was required to
appear for Special Registration? _____ Yes _____
No
If yes, did you register?
- Are you married? ______ Yes _____ No
(if yes, please complete the following):
Spouse’s Name: Last/Family Name:
_________________________
First/Given Name: _________________________
Spouse’s Present Address (if same, state
“SAME”): _________________________
Date of Birth: City and Country of Birth:
_________________________
Social Security Number:
_________________________
Current Immigration Status:
_________________________
Expiration Date: _________________________
Country of Passport Issuance:
_________________________
Passport Expiration Date:
_________________________
- Please list prior periods of stay in the
U.S. (if none, state “NONE”):
Entered: ____________ Departed:
____________Status: ____________
Entered: ____________ Departed:
____________Status: ____________
- Please list all periods of employment in the
U.S. (if none, state “NONE”):
Company: ______________ Duration:
______________ Status: ______________
Company: ______________ Duration:
______________ Status: ______________
Company: ______________ Duration:
______________ Status: ______________
IF YOU ARE CURRENTLY
ON AN H-1B VISA - PLEASE PROVIDE OUR OFFICE WITH
A RECENT PAYSTUB TO PROVE CONINUED EMPLOYMENT
- Do you have any children? (If yes, please
complete the following for each individual
child)
Child’s Name: _________________________
Last/Family Name: _________________________
First/Given Name: _________________________
Child’s Present Address:
__________________________________________________
Date of Birth: _________________________
City and Country of Birth:
_________________________
Country of Citizenship:
_________________________
Social Security No.: _________________________
Current Immigration Status:
_________________________
Expiration Date: _________________________
Country of Passport Issuance:
_________________________
Passport Expiration Date:
_________________________
CONSULATE INFORMATION
– MUST BE COMPLETED EVEN IF IN US
- What is the location of the U.S. Consulate’s
Office where the application for the visa will
be picked up (for Canadian citizens, name U.S.
Port of Entry)? Even if you are in the US,
please list the consulate you would use in the
event that the CIS requires you to obtain a visa
abroad.
City: Country: _________________________
IF APPLICANT IS IN THE U.S.
- What was the date of your last entry to U.S?
_________________________
What was the place of your last entry to U.S?
_________________________
- What is your current visa status?
_________________________
What is the date your authorized stay
expires? _________________________
- Please list all periods of employment in the
United States (if none, please state “NONE”; if
you were a contracted employee, please state the
name of your actual employer not the client to
whom you were contracted)
Company: ____________ Duration:
____________ Status: ____________
Company: ____________ Duration: ____________
Status: ____________
Company: ____________ Duration: ____________
Status: ____________
- If you have ever been in H or L status,
please list the date you first acquired the visa
status.
_________________________
If you were in the United States and obtained a
change of status, please list the official start
date.
________________________
If you obtained your H or L status abroad,
please list the date you first entered the
United States in H or L status.
First entry date: _________________ in [choose
one] ___ H ___ L status.
- Do you (or your family) have any plans to
travel abroad within the next three to four
months? If so, please complete the following:
Destination: Planned Duration of Trip:
_________________________
Start: _________________________
End: _________________________
- May we contact you at work? _____ Yes _____
No
- Are there any specific issues you are
concerned about or wish to bring to our
attention?
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