Employee Checklist-Questionnaire: E-3

Please provide copies ONLY – The USCIS will not receive originals

□  Passport biographical page (page with photograph) and, if applicable, page extending passport validity.

□  U.S. visa sticker stamped in the passport used for latest entry into the U.S.

□  Front and back of I-94 card (white card received upon entering the U.S.)

□  All Forms I-20 (if in F-1 status) or DS-2019 (if in J-1 status), if applicable

□  Employment Authorization Card (EAD), if applicable (you would have one if in OPT)

□  USCIS notices (form I-797) for approval or denial, if applicable

□  Up-to-date Curriculum Vitae/Resume

□  Copy of post-secondary degrees and corresponding transcripts (include certified translation and educational equivalency evaluation if degree is foreign)

Last Name / First Name / Middle Name
Social Security Number: / Alien Number (A#, A Number, USCIS#) (if applicable):
U.S. Home Address:
Foreign Address:
Maiden name or other names used (if applicable)
Where would you apply for E-3 Visa abroad?* / City: / Country:

*”Visa” is the document stamped in the passport that allows you to enter the U.S. When applying for new E-3 from inside the U.S., you may be required to complete the process by obtaining the visa abroad at the consulate you specify. Visa stamping is required if applying for new E-3 from outside the U.S.

What is your current immigration status?
Have you ever been in the U.S. in E-3 status? / YES / NO / If yes, from / to
Have you ever been denied E-3 classification? / YES / NO
Have you ever been in the U.S. in J-1 status? / YES / NO / If yes, from / to
Have you ever been in the U.S. in J-2 status? / YES / NO / If yes, from / to
Are you in removal proceedings? / YES / NO
Has UH ever filed a petition I-140 (permanent residence) for you? / YES / NO
Do you have dependent(s) applying with you? / YES / NO / If yes, how many?

See next page for instructions on dependents.

I attest that all the documents provided are true copies of the originals AND that the information above is true and accurate.

Your Name / Your Signature / Date

This Information Applies if You’ve Indicated You Have Dependents Applying With You

** Note on Dependents (ignore this if you’re applying for E-3 from outside the U.S.) The UHS Immigration Specialist does not prepare the packet (Form I-539 and supporting documents) pertaining to the H-1B worker’s dependent(s)’s visa/status. However, we may include your dependent(s)’s I-539/E-3 Dependent packet with your E-3 packet so they’re processed at the same time. Just make sure you prepare the forms, put together the supporting documents and immigration-fee check or money order for your dependent(s) and give to the Immigration Specialist. The Immigration Specialist may not provide advice or guidance on proper completion of the I-539 form and packet. Form I-539 and instructions can be found at http://www.uscis.gov/i-539

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