Office of International Students & Scholars
H1-B Questionnaire________________________________________________________________________________________
Please submit completed form to your hiring department at Lehigh University.
All information is required. Please do not leave any blanks.

Name (as appears in passport): _____________________________________________________________________
Family/Last

Given/FirstMiddle

Other Names Used (if applicable): ___________________________________________________________________
Email Address: _____________________________

Phone Number: ______________________________________

LIN ID (if applicable): ________________________ Social Security # (if applicable): ________________________
Passport Number: ___________________________ Passport Issued: _____________________________________(Month/Day/Year)

Expiration of Passport: ____________________________________________________________________________(Month/Day/Year)

Date of Birth: _______________________________Country of Birth: _____________________________________(Month/Day/Year)

Province/State of Birth: _______________________ Country of Citizenship: _______________________________Country of Permanent Residence: ______________ Highest Degree Earned: ______________________________
Major Field of Study: ______________________________________________________________________________Name & Address of Degree Granting Institution: _______________________________________________________
Foreign Address: _________________________________________________________________________________
Street Address_____________________________________________________________________________________________________________City

StatePostal CodeUS Address: ______________________________________________________________________________________
Street Address_____________________________________________________________________________________________________________City

State

Have you held H1B or H4 status within the last six years?
If yes, please list dates and status held:
Have any family member (s) held H1B or H4 status in the last six years?
If yes, please list names, dates, and status held:

Postal CodeYes

NoYes

NoYes

NoYes

NoYes

No

Have you ever been denied a petition for H1B status?
Have you ever been in J-1 or J-2 status?
If yes, were you subject to the 2-year home residency requirement?

Office of International Students & Scholars
H-1B Questionnaire (continued)________________________________________________________________________________________
Please submit completed form to your hiring department at Lehigh University.
All information is required. Please do not leave any blanks.

Have you returned home for 2 years or received a waiver?

YesNoYesNo

Have you ever been in exclusion or deportation proceedings?

Yes

No

Are you currently residing in the United States?

Yes

No

Have you ever applied for US Permanent Residency (green card)?
On what basis did you apply?

If currently OUTSIDE of the United States:
Address of Consulate/Embassy where you will apply for visa: ___________________________________________
When do you plan to enter the US? ___________________________________________________________(Month/Day/Year)
If Canadian, which Port of Entry do you plan to use? ___________________________________________________

If currently IN the United States:Current Immigration Status: __________________ Expiration of Current Status: ___________________________(Month/Day/Year)
Expiration of Work Authorization (if applicable): ________________ Expiration of Visa: ______________________(Month/Day/Year)(Month/Day/Year)

I-94 Number: _____________________________________________________________________________________
Date of last entrance to US (as listed on I-94 card): ________________ Expiration of I-94: ____________________(Month/Day/Year)(Month/Day/Year)

Do you plan to travel outside the US while your H1B petition is pending? Yes / No
If yes, list places and dates of travel: ________________________________________________________________
If you are currently employed elsewhere, where are you employed? ______________________________________
When do you expect to terminate that employment? ___________________________________________________**If you are currently in H1B status, you should not terminate your current employment until a new H1B application by
Lehigh University has been submitted and a receipt has been received from immigration services.
Do you have a spouse or children who will apply for, or extend, H4 dependent status? Yes / No
Please list name, date of birth, and current visa status for each non-US citizen dependent.