Non-Immigrant Category Questionnaire

NON-IMMIGRANT CATEGORY QUESTIONNAIRE

(for H-1B, TN, O-1, and H-1B1 visa types)

Please give questionnaire to the prospective foreign national employee requiring sponsorship for non-immigrant employment authorization

I.PERSONAL INFORMATION

Name:

(Last), (First), (Middle)

Other names: Sex: Male Female

(Maiden, Religious, Professional, Aliases)

Date of birth: Place of birth:

(Mo/Day/Yr)(City), (State), (Country)

Citizenship: U.S. Social SecurityNo.

(Country)

Permanent address abroad:

Telephone: Facsimile:

U.S. address:

Telephone: Facsimile:

Cell phone: Work Phone:

Work e-mail address:

If in the U.S., complete the following:

Date of most recent arrival: I-94No.:

Mo/Day/Yr)

Current nonimmigrant status: Expires:

(Mo/Day/Yr)

Place where last entered U.S.: Means of travel into U.S.:

Did you talk with a Border or Pre-Flight Inspector on entry into U.S.?

Please list all nonimmigrant statuses you have had.

Status
(e.g., F-1, J-1, L-1, TN, H-1B, etc.) / Status
Start Date / Status
End Date

PassportNo.: Date issued: Date expires:

(Mo/Day/Yr)(Mo/Day/Yr)

Color of hair: Color of eyes: Complexion: Height:

Marks of identification:

Were any of your or your spouse’s parents or grandparents born in the United States? Yes No

If so, when?

II.FAMILY INFORMATION

Marital status: Married Widowed Divorced Separated Single

Names and relationships of persons traveling with you:

Last, First, Middle / Relationship / Date of Birth / Place of Birth / Date of Marriage (for spouse) / Current Visa Status

Do you have any children who are within four years of the age of 21 who may eventually want to live permanently in the U.S.? Yes No

Please list all nonimmigrant statuses your spouse has had.

Spouse’s Nonimmigrant Visa History
Status
(e.g., F-1, J-1, L1, TN, H1B, etc.) / Status
Start Date / Status
End Date

III.EDUCATION

School Name/Address / Field of Study / From
(Mo/Yr) / To
(Mo/Yr) / Degree

List professional licenses:

IV.PRIOR WORK EXPERIENCE
(if additional space is required, use back of sheet)

Employer:

Address:

Employed: From (mm/dd/yyyy) ______to (mm/dd/yyyy) ______Hrs. per week:

Job title:

Job duties:

Employer:

Address:

Employed: From (mm/dd/yyyy) ______to (mm/dd/yyyy) ______Hrs. per week:

Job title:

Job duties:

Employer:

Address:

Employed: From (mm/dd/yyyy) ______to (mm/dd/yyyy) ______Hrs. per week:

Job title:

Job duties:

VII.IMMIGRATION-RELATED QUESTIONS

How long do you intend to stay in the U.S.?

At which U.S. Consulate (outside of U.S.) will you obtain your H-1B visa?

City: Country:

If Canadian citizen, where do you intend to enter the U.S.?

Are either you or your spouse an American Indian born in Canada of at least 50 percent Native bloodline? Yes No

Are either you or your spouse eligible for a Native American tribal document? Yes No

Pre-flight inspection: Port of entry:

Ever under immigration proceedings?

Exclusion Deportation Rescission Judicial proceedings

Where: When:

Has anyone ever filed an immigrant visa petition on your behalf? Yes No

Has labor certification for employment in the U.S. ever been requested by you or on your behalf? Yes No

Have you or anyone acting for your ever indicated to a U.S. consular or immigration employee a desire to immigrate to the U.S.? Yes No

Ever applied for a U.S. immigrant visa before? Yes No

If yes, Where: When: Outcome:

Ever applied for U.S. permanent residency before? Yes No

If yes, explain:

A No.:

Ever applied for a U.S. nonimmigrant visa before? Yes No

If yes, Classification: Where: When:

Outcome? Issued Refused

Classification: Where: When:

Outcome? Issued Refused

List any prior periods of stay in H-1B classification in the U.S., for you or your dependent family members, over the last six years

Ever denied H-1B classification? Yes No

Has your U.S. visa ever been canceled? Yes No

If yes, Where: When: By whom:

Does your spouse or any of your children intend to work in the U.S.? Yes No

If yes, explain:

Does your spouse or any of your children intend to study in the U.S.? Yes No

Who will furnish financial support, including airline tickets?

Have you ever been in the U.S.? Yes No

If yes, When? For how long?

Are any of the following in the U.S.? (If yes, check appropriate relationship and indicate what that person is doing in the U.S., i.e., studying, working, etc.)

Husband Wife Fiance/Fiancee Brother Sister Father Mother Son Daughter

Please list the countries where you have lived for more than six months during the past five years.

Country / City / Approximate Date
From (Mo/Yr) / To (Mo/Yr)

VIII.GROUNDS OF EXCLUSION

Are you afflicted with a contagious disease (i.e., tuberculosis) or have you suffered from a serious mental illness?

Yes No

Have you ever been fingerprinted, arrested, convicted for any offense or crime even though subject of a pardon, amnesty, or other such legal action? Yes No

If yes, please explain:

Are you a narcotic addict or trafficker? Yes No

Have you ever been deported from the U.S. within the last five years? Yes No

Have you ever sought to obtain a visa by misrepresentation or fraud? Yes No

Have you ever been a member of certain organizations, including Communist organizations and those affiliated therewith? Yes No

Have you ever ordered, incited, assisted or otherwise participated in the persecution of any person because of race, religion, national origin, or political opinion under the control, direct or indirect, of the Nazi Government of Germany, or of the government of any area occupied by, or allied with, the Nazi Government? Yes No

I, , certify that the information provided on this questionnaire is true and correct to the best of my knowledge.

Date:

Signature

NOTE: UNLESS AN EXPLICIT AGREEMENT REGARDING DEPENDENTS HAS BEEN REACHED BETWEEN YOU AND CWU, YOU WILL BE RESPONSIBLE FOR ALL ATTORNEYS’ FEES, COSTS AND FILING FEES RELATED TO THE FILING OF IMMIGRATION PAPERS FOR EACH OF YOUR DEPENDENTS. PLEASECONTACT THE CWU HR DEPARTMENT IF YOU HAVE ANY QUESTIONS OR CONCERNS.

This questionnaire is for information collection purposes only. It will not be filed with the USCIS.

Non-Immigrant Category Questionnaire, Page 1 of 1

DOCUMENT CHECKLIST

[Please forward copies of documents to the CWU HR Department. Electronic (emailed) copies are preferable.]

[DO NOT SEND ORIGINALS]

If you are not currently employed or resident in the United States, please submit:

copy of your entire passport, including all pages (even if blank)

copy of your university diploma(s) with transcripts. Any translations you submit must be certified. If you have a prior educational evaluation,verifying equivalency to a U.S. degree, please submit that as well.

copy of your current, up to date,resumė.

copy of your birth certificate - if available, long form with names of both parents. (Note: if you do not have a birth certificate {short or long form} readily available, please send what other documents you have – the attorneys will inform you when/if they need the birth certificate.)

copy of marriage certificate (if applicable).

copy of all prior H-1B, TN, O-1, E-3, or H-1B1 approval notices, if you have previously been employed in the United States.

copy of your Form(s) I-20 (F-1 only.), or Form(s) IAP-66 or DS-2019 (J-1 only) if you have previously been a university student or scholar in the United States.

copy of your Employment Authorization Document (EAD) card, if you were previously employed, as an F-1 student, in Optional Practical Training Status. Please make sure all dates are legible. (F-1 only.)

If you are in the United States in H-1B status, please submit:

copy of all prior H-1B approval notices.

prior to obtaining H-1B status:

if you were a student in the United States, please provide a copy of your Form(s) I-20 (F-1 only) or Form(s) IAP-66 or DS-2019 (J-1 only);
if you were employed in the United States as a student in F-1 Option Practical Training (OPT), please provide a copy of your Employment Authorization Document (EAD Card – both front and back of the card), or
if you worked in the United States under a different employment authorization type, please provide a copy of your previous employment authorization document(s) [for J-1s, a copy of your DS-2019 (IAP-66); for L-1, a copy of your L-1 approval notice(s); for TNs, a copy of your I-94 or I-797 approval notice; etc.]

copy of your entire passport, including all pages (even if blank). Please make sure all entry/exit stampsand notations are as legible as possible.

if your passport has been replaced/renewed since your initial entry to the United States, copy of your previous passport(s), including all pages (even if blank). Please make sure all entry/exit stampsand notations are as legible as possible.

copy of the front and back of your current I-94 card (small card stapled in passport). Please make sure all stampsand notations are as legible as possible.. If your entry to the U.S. was recorded electronically by US Customs and Border Protection, a copy of your electronic I-94 record of admission. The electronic record can be retrieved from

copy of your three most recent pay stubs or pay vouchers, copy of your last year’s W-2 form, and a copy of your most recently filed federal income tax return.

copy of your diploma, with transcripts. Any translations you submit must be certified. If you have a prior foreign education evaluation, verifying equivalency to a U.S. degree, please provide that as well.

copy of your current, up to date, resumé.

copy of marriage certificate (if applicable).

If you are in the United States in H-4 status, please submit:

copy of your spouse’s current H-1B approval notice.

copy of your spouse’s passport ID page.

copy of your entire passport, including all pages (even if blank) and your H-4 visa.

if your passport has been replaced/renewed since your initial entry to the United States, copy of your previous passport, including all pages (even if blank), including the visa stamp on your initial entry.

copy of the front and back of your current I-94 card (small card stapled in passport). Please make sure all dates are legible. If your entry to the U.S. was recorded electronically by US Customs and Border Protection, a copy of your electronic I-94 record of admission. The electronic record can be retrieved from

copy of your spouse’s two most recent pay stubs or pay vouchers, and a copy of most recently filed federal income tax return.

copy of your diploma, with transcripts if possible. Any translations you submit must be certified. If you have a prior foreign education evaluation (verifying equivalency to a U.S. degree), please submit that as well.

copy of your marriage certificate.

copy of your birth certificate(s) - if available, long form with names of both parents. (Note: if you do not have a birth certificate {short or long form} readily available, please send what other documents you have – the attorneys will inform you when/if they need the birth certificate.)

copy of your resume.

If you are in the United States in TN or F-1 status, please submit:

copy of your entire passport, including all pages (even if blank) and current F-1 visa (or visa used to enter the U.S.).

copy of your current Form I-20 showing OPT/CPT status, and all previous Forms I-20 (F-1 only).

copy of your Employment Authorization Document (EAD) card. Please make sure all dates are legible. (F-1 only.)

copy of your two most recent pay stubs or pay vouchers, copies of all previous W-2 forms, and a copy of your most recently filed federal income tax return (for TNs and F-1 OPT/CPT status).

copy of your resume.

copy of your birth certificate(s) –if available, long formwith names of both parents. (Note: if you do not have a birth certificate {short or long form} readily available, please send what other documents you have; we will inform you when/if a birth certificate is needed.)

copy of marriage certificate (if applicable).

If Dependents will be included, please provide the following information for each Dependent:

copy of each Dependent’s entire passport, including all pages (even if blank)

if a Dependent’s passport has been replaced/renewed since their initial entry to the United States, copy of previous passport, including all pages (even if blank), including the visa stamp on initial entry.

copy of the front and back of current I-94 card (small card stapled in passport). Please make sure all dates are legible. If your dependent’s entry to the U.S. was recorded electronically by US Customs and Border Protection, a copy of your electronic I-94 record of admission. The electronic record can be retrieved from

copy of Approval Notice(s) issued to each Dependent since they have been in the United States (if applicable), including H-4 Approval Notices, and any Approval Notice(s) issued for another category (e.g., F-2, as an F-1 dependent)

if a dependent child, copy of birth certificate, long form with the names of both parents.

if you are in TN status, and your spouse or dependent child/ren do not travel on Canadian passports (i.e., are not Canadian citizens), then please provide a copy of their TD visa(s) and indicate at which U.S. Consulate abroad they would apply for a new TD visa:

(needed for re-entry to the United States after travel abroad – if dependent(s) intend to remain in the United States without travelling, then no new TD visa is required).

Non-Immigrant Category Questionnaire - Document Checklist, Page 1 of 6