H-1B Request Form

(Completed by Hiring Department)
Office of International Students & Scholars
Tel: 610-758-4859, Fax: 610-758-5156

Type of Petition (select one):☐Initial Employment (first time working at Lehigh University in H-1B status)☐Extension- Continuation of previously approved H-1B employment without substantial changes☐Amendment- Substantial change in previously approved H-1B employment☐Concurrent Employment- Will continue at another place of employment and will work simultaneously at Lehigh

Employee (Beneficiary Information):
Name (Last, First, Middle Initial):
Email address:
Is employee currently in the U.S.? ☐ YES or ☐NO
Hiring Department/ Supervisor Information:
Hiring Department:

Contact Information:

Name of Supervisor:

Supervisor Title:

Supervisor Phone #:Supervisor Email Address:

Departmental Index number*:Position Information:
Requested Employment Dates (not to exceed threeyears):
toWages/Year:

Position Description (non-technical):

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H-1B Conditions Acceptance
The Department understands that (please initial):
The employment of the H-1B nonimmigrant will not adversely affect the working conditions ofemployees similarly employed in the area.
The salary being paid to the above-named employee is at least the actual wage being paid to all other individuals
with similar experience and qualifications for the specific employment in question or the prevailing wage level for theoccupation, whichever is higher.
A notice of filing will be sent to you and will be posted for 10 working days in at least two conspicuous
locations where the H-1B nonimmigrant will be employed.
The vacation time, sick leave and other benefits offered to this employee are equivalent to that offered to otherU.S. workers in the same classification.
Any change in employment or material change in working conditions must be reported to OISS immediately. This
includes changes in responsibilities, such as reassignment of duties, changes in salary or if the employee is assigned to aposition at a new location.
The H-1 may not receive payment from any source other than Lehigh University payroll
unless under concurrent H from other employer.
If the department terminates this employment before the expiration of the H-1B status, the department isrequired to report this immediately to OISS and is responsible for the reasonable transportation costs of returning theemployee to their home country.

Signature
As Department Head, I understand the conditions as stated above and will comply with all requirements.
Signature:Date:

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Prevailing Wage Worksheet

Office of International Students & Scholars
Tel: 610-758-4859, Fax: 610-758-5156

This form should be completed based on information for the position, not the individual. This information is required forOISS to obtain the prevailing wage from the U.S. Department of Labor.
Position Information
Position Title:☐Full-Time OR☐Part-Time*

If PT, # of hours of work/week:*Complete PT certification sheet.
Is position eligible for overtime? ☐Yes OR☐No

Hourly work schedule:

toThis position is a ☐12-month appointment OR ☐ 9-month appointment.
Title of worker’s immediate supervisor:
Description of the duties to be performed (may use technical terms):

Minimum degree required: ☐Bachelors☐ Masters ☐Doctorate/PhD ☐Other (specify JD, MD, etc.)

Major fields of study required:
Is a second U.S. diploma/degree required? ☐ Yes ORIs employment experience required? ☐ Yes OR☐No☐NoIf yes, specify the # of months/years required:

Is training or professional license for the job required (this not does include on-the-job training, but a special trainingprogram)? ☐ Yes OR ☐No
If yes, please specify:

Does the position include supervisory (non-student) duties? ☐Yes OR
If yes, indicate the # and level of employees being supervised:☐No

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Will travel be required in order to perform the job duties? ☐Yes OR ☐No
If yes, provide details of travel (location, frequency and nature):

Address Where Person Will Work:
Street:State:City:County:Zip Code:Will work be performed at multiple worksites? ☐Yes OR ☐No
If yes, please attach to this form a list of complete addresses of all anticipated worksites. You do not need to list
additional on- campus worksites, only those that are off- campus.

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Statement of Actual Wage
Office of International Students & Scholars
Tel: 610-758-4859, Fax: 610-758-5156

H-1B Employee’s Name (Last, First, Middle):
Position Title:

Salary:Department:
In order to process this H-1B application, we must determine the actual wage being paid to all other individuals withsimilar experience and qualifications at the place of employment. Please provide the necessary information for all
employees in your department who are similar to the H-1B in the terms specified below:☐ No one in this unit is similar to the prospective H-1 in terms of education, experience and job responsibilities.
☐ Individuals in the positions listed below are similar to the prospective H-1B nonimmigrant in terms of all of thefollowing- Same degree, same or related major field, same amount of post-graduation work experience, similar
duties and responsibility, even if job title is different. Include U.S. workers and nonimmigrants in the assessment, but
not the individual to whom the H-1B application pertains.
Position Title (no names):

Salary:Statement of Working Conditions
I certify that employing this H-1B nonimmigrant will not adversely affect the working conditions of workers similarly
employed in the area of intended employment in regards to such matters as hours, vacation periods and fringe benefits.
In the event that a complaint is filed, I will be able to show that the working conditions are similar to working conditions,which preceded the employment of the H-1B nonimmigrant.
Signature of Department Head or Director:

Date:Print Name and Title:

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H-1B Part-Time Certification

Office of International Students & Scholars
Tel: 610-758-4859, Fax: 610-758-5156

Only complete this form if position is part-time
An H-1B worker may be employed part-time provided the Labor Condition Application (LCA) and H-1B petition state thatthe H-1B worker will work only part-time. For part-time positions, an employer must always express the prevailing wage
as an hourly wage, even if the worker is paid a salary.
An employer may not sponsor an H-1B worker for full-time employment and then only pay him or her for part-time
employment. A change from full-time to part-time is considered a material change that requires the employer to file anamended petition.
••

DOL regulations required employers to keep records of “hours worked each day and each week” for all part-time
H-1B employees regardless of whether or not the part-time employee is paid a fixed salary.
Employer is required to keep such hourly records for its H-1B part-time salaried employees, even if it does not forother part-time workers.

This requirement places an additional burden on employers who hire part-time salaried employees for whose hours are
not necessarily tracked. Departments who do not already keep records of hours worked for such employees face thechoice of implementing a system to track hours worked by their part-time salaried H-1Bs or deciding not to do H-1B
petitions for part-timers and adjuncts.
When hiring an H-1B for less than full-time the department agrees to keep track of all hours worked for this part-time
employee and to have this written information available to give to the Department of Labor in case of an audit.
Name of Part-time Employee:
Department Chair Signature:Date:

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