ࡱ> _ k,bjbj @bb"` ` 8NL(6>t NNNNNNN$P@S7N667N4LN!!!N!N!!MF0IPld"v}G$MbN0NGZTrZTHIIZTaJ!7N7N NZT` :  H-1B/O Petition Questionnaire for the beneficiary NAMEFirstMiddleLastMaidenaPPLICANTS InformationHome phone number Work phone number Cell phone number e-mail address Current Address in the United States: Number and Street, City/Town, State & Zip Code, Country Current/last address outside the United States (please provide in the following format): House Number and StreetApartment Number CityZip Code, Country Country of Birth:City/Town/Province of Birth:Date of Birth (Month/Day/Year):Country Passport Issued From:Passport Number:Issue Date:Expiration Date:Country(ies) of Citizenship:U.S. Social Security Number:IMMIGRATION PROCESSING INFORMATION Your current status in the U.S.U.S. Visa Category (B,E,F,H,I,J, etc) When/where issued: expiration date (on I-94; may be D/S) I-94 Entry/Departure Record Admission Number: Entry Valid Until (Date):  HYPERLINK "https://i94.cbp.dhs.gov/I94/request.html" https://i94.cbp.dhs.gov/I94/request.htmlLast Entry into U.S.: When & Where At which U.S. embassy or consulate would you obtain a visa Have you had H-1 status in the past 7 years? If yes, give dates and name(s) of employer(s) and most recent USCIS petition numberList dates of prior periods of stay in the U.S. for the past six years (only in H1B status):Have you ever been denied H/O/E Status? If so, give details What was your first date of entry into the U.S. in your current status (Please check your I-94 Departure Record):Do you have an application for US Permanent Residence in progress? If yes please provide details:Has your immigration status ever changed in the U.S.? If yes: Please explainHave you ever been in the U.S. as a J-1 Exchange Visitor? If yes: When:Are you subject to the 212(e) two-year home residency requirement? (for J visa) If you fulfilled your 2-year Home Residency Requirement please provide evidence (e.g. USCIS approval of I-612 waiver form I-797)Have you ever been the subject of a deportation proceeding? If yes: When/Where/OutcomeHave you ever claimed to be a U.S. citizen either on an I-9 or any other federal document? Yes/No? If yes: Please explainHave you ever made a fraudulent statement or misrepresented a fact to obtain or try to obtain any immigration benefit from the U.S.? Yes/No? If yes: Please explainDid you ever have an employment authorization document (EAD) for optional practical training (OPT) in F-1 status as an international student? If so, did you have more than 60 days of unemployment during your approved period of OPT? If yes, please explain your periods of unemployment during OPT in detail.If in the U.S., do you have plans to travel abroad? If yes: Provide details of your travel plansEDUCATION/WORK DETAILS Current Occupation:Provide your education and experience (please list the following information for all colleges/universities attended if information is not listed on your resume/curriculum vitae): Name of University/College/School, Location, Field of Study, Start Date (Month/Year), Finish Date (Month/Year), Degree/Certification/Diploma ReceivedProvide the following information for each employer for the past five years if information is not listed on your resume/curriculum vitae. Name of Employer, Address, Occupation/Title, Start Date (Month/Year), Finish Date (Month/Year)JOB LOCATION Physical location where you will be working based on the new immigration approval you are seeking now:DEPENDENT(S) INFORMATION IF filing for dependents Please note: this information only required if you are filing for a change of status in the US, if you are outside the US and will apply for a visa, do not fill out this section. Marital Status (Single, Married, Separated, Divorced, or Widowed):Dependent(s) Information your will need to provide Full name (including maiden name) Date of Birth City/Country of Birth Country(ies) of Citizenship Date of Marriage City/Country of Marriage U.S. Immigration Status Social Security Number (if any) Present AddressTeachers College does not review petitions or pay fees for dependents, but for your convenience we will include documents you provide with your petition. You need to contact an immigration attorney if you have any questions in reference to your dependents applications. http://www.uscis.gov/i-539 Additionally please note: H1B employers and employees are subject to random site checks (visits) by the Department of Homeland Security. DHS officers and contractor may visit Teachers College and ask questions related to employment of H1B employees. DOCUMENTS CHECKLIST Please prOVide one set of clear copies on 8-1/2 x 11 paper, one-sided or send documents as PDF files by e-mail to potapova@tc.edu. If any documents you are submitting are not in English, please provide English translation and translators affidavit (you cannot be a translator) Thetranslator(cannot be you) must certify that s/he is competent totranslateand that thetranslationis accurate. The certification format should include the certifier's name, signature, address, and date of certification. A suggested format is: Sample Certification byTranslator I[typed name], certify that I am fluent (conversant) in theEnglishand ________ languages, and that the above/attached document is an accuratetranslationof the document attached entitled _________________________________________ Signature__________________________________________________________________________________________ Date Typed Name Address *Your passport pages: (picture/biographical identification pages; any pages with American Consulate issued visas; any pages with U.S. entry stamps). *Most recent I-94 card, front and back and/or electronic I-94  HYPERLINK "https://i94.cbp.dhs.gov/I94/request.html" https://i94.cbp.dhs.gov/I94/request.html *Copies of previous I-94 cards *Documents showing evidence of your prior and current status in the U.S. (Submit all that apply): Form(s) I-797 H-1 approval notice Employment Authorization Document(s) (EAD card) Form(s) I-20 (evidence of F-1 student status) Form(s) IAP-66 and/or DS-2019 (evidence of J-1 status) If you fulfilled your 2-year Home Residency Requirement please provide evidence (e.g. USCIS approval of I-612 waiver form I-797) *You current resume/CV *Educational documents, including all of the following that apply: Copies of official transcripts(that includes course lists, marks, etc.) Copies of theactualdegree, diploma, certificate or similar award Any other official documentation from the schools Office of the Registrar(if 1 & 2 not available or in addition to 1&2)(that usually applies to ABD - when coursework is completed, but a degree has not been awarded yet). An evaluation from an educational evaluation agency, if you obtained your degree outside the United States *If this is continuing employment in H-1B or other status (J, F-1/OPT), copies of your most recent W-2 annual wage statement and pay stubs (12 months). *Dependents (Spouse & Children) only if you are currently in the US/changing status. Please do not submit documents for dependents if you will apply for a visa outside the US. Marriage Certificate Birth Certificate Most recent I-94 card, front and back. and/or electronic I-94  HYPERLINK "https://i94.cbp.dhs.gov/I94/request.html" https://i94.cbp.dhs.gov/I94/request.html Passport pages: (picture/biographical identification pages; any pages with American Consulate issued visas; any pages with U.S. entry stamp). Please note: we will include your dependents documents with your application, but we will not review or pay fees. You need to contact USCIS or an immigration attorney if you have any questions.  HYPERLINK "http://www.uscis.gov/i-539" http://www.uscis.gov/i-539 Please note: your eligibility for H1B visa/status depends on your compliance with immigration law and education credentials (we must show that you have a required degree/work experience in a specific filed). If USCIS finds documentation insufficient (incomplete or inaccurate) they could deny or significantly delay processing of our petition by issuing a request for additional evidence. Please also submit a letter as shown below, to accompany copies of your original documents. Department of Homeland Security/USCIS California Service Center 24000 Avila Road Laguna Niguel, CA 92677 To Whom It May Concern: Copies of documents submitted are exact copies of unaltered original documents, and I understand that I may be required to submit original documents to an immigration or consular official at a later date. Sincerely, ____________________________ (signature) Print name Address Date      Please fill out and return this form with supporting documents to the Office of the General Counsel ATT: Viktoria PotapovaBy mail: Teachers College, Columbia University 525 West 120th Street, Box 83 or Room 107 Zankel New York, NY 10027By e-mail (preferred) :  HYPERLINK "mailto:potapova@tc.edu" potapova@tc.edu By fax: +(212) 678-8306   PAGE \* MERGEFORMAT 6 3489:;ABCJLQRSZ\eghtv˿wmwcXQX hDhdhy$hdCJaJhy$hd5;hy$h\5;hy$hJ%85;hy$hc"5CJaJ hDhc"hy$hc"CJaJ *hy$hc"CJaJ *hy$hc"5 *hy$h2k5hX`hc";OJQJha;OJQJhX`h;OJQJhNc;OJQJhX`hd;OJQJhCJ\]aJ49:;ABEkd$$Ifl00*  t0644 lapyty$ $Ifgd $Ifgdy$$a$gdg$a$gd#BCJKvmd $Ifgd $Ifgdy$kd$$Ifl00* t0644 lapyty$KLQRvmd $Ifgd $Ifgdy$kd\$$Ifl00* t0644 lapyty$RSZ[vm]$ $Ifa$gddt $Ifgdy$kd$$Ifl00* t0644 lapyty$[\tuvmd $Ifgd $IfgdDkd$$Ifl00* t0644 lapyty$uvg^U $Ifgd $Ifgdy$kd9$$Ifl00*  t0644 lapyty$vmd $Ifgd $Ifgdy$kd$$Ifl00* t0644 lapyty$' ( ) * 8 Q W üឋxmhy$hC CJaJ hDhC hy$h(Q5CJaJhy$h(QCJaJh(Qhd6h(Qh(Q6h(QhdB*phh(Qh(QB*ph h(Qh(Qh(Q h(Qhd h(QhY">hY">h"j)hxghy$hdCJaJ hDhdhy$hd5CJaJ(vmd $Ifgd $Ifgdy$kd$$Ifl00* t0644 lapyty$vmd $Ifgd $Ifgdy$kd4$$Ifl00* t0644 lapyty$' ( vmmd $Ifgd $IfgdDkd$$Ifl00* t0644 lapyty$( ) vm`W $Ifgd & F$Ifgd(Q $IfgdDkdr$$Ifl00* t0644 lapyty$ vi` $Ifgd & F$Ifgd(Qkd$$Ifl00* t0644 lapyty$ vi` $Ifgd & F$Ifgd(Qkd$$Ifl00* t0644 lapyty$ vi` $Ifgd & F$Ifgd(QkdO$$Ifl00* t0644 lapyty$ vmd $Ifgd $Ifgd(Qkd$$Ifl00* t0644 lapyty$ vmd $Ifgd $IfgdDkd $$Ifl00* t0644 lapyty$  vmd $Ifgd $Ifgdy$kd, $$Ifl00* t0644 lapyty$  ! ? 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