H1B Employment Registration Form

H1B EMPLOYMENT REGISTRATION FORM

This form collects the personal, immigration, employment, and education information required to evaluate and register a prospective employee for an H‑1B petition. The information provided will be used to prepare immigration filings and to verify eligibility for employment. The registrant must provide truthful, complete responses and required supporting documentation upon request.

Personal Information

Date of Birth:    Place of Birth (City, Country):

Phone:    Email:

Immigration and Status Details

Are you currently in the United States?   Yes    No

F-1 (including OPT)    H-1B    H-4    L-1    TN    E-3    Other:

Date of Last Entry to U.S.:    I-94 Number (if any):

Alien Registration Number (A#) (if any):

Position Information for H‑1B Registration

Reporting Manager:    Worksite Address:

Proposed Start Date:    Offered Annual Salary (USD):

Employment History (Most Recent)

Title:    Start Date:    End Date:

Title:    Start Date:    End Date:

Education

Graduation Date:    Major / Field of Study:

Professional References

Legal Disclosures and Authorizations

At‑Will Employment: Nothing in this registration or any related correspondence constitutes an employment contract. Employment, if offered and accepted, will be at‑will unless a separate written agreement states otherwise.

Equal Opportunity: The employer is an equal opportunity employer. Employment decisions are made without regard to protected characteristics except where bona fide occupational qualifications apply.

Authorization to Contact and Verify: By signing below, I authorize the employer and its authorized representatives to contact prior employers, educational institutions, and references to verify information provided herein. I authorize background, criminal record, and immigration status verification checks as required for petition preparation and employment eligibility verification.

Disclosure of Immigration-Related Information: I understand that filing an H‑1B petition will require the employer to collect copies of identity and immigration documents. I agree to provide accurate documentation promptly and to notify the employer of any material change in status or circumstances that may affect eligibility.

Criminal History and Material Misrepresentation: I certify that I have disclosed any prior convictions, immigration violations, removals, or proceedings in the space below. I understand that material misrepresentation or failure to disclose relevant information may result in denial of immigration benefits and employment consequences.

Consent to Background and Reference Checks: I consent to background checks and contact of prior employers and references for verification purposes.

Applicant Certification

I certify under penalty of perjury that the information provided on this form and any attachments is true, correct, and complete to the best of my knowledge. I understand that providing false information may subject me to adverse employment action and immigration penalties. I authorize the release of information necessary to prepare and file immigration petitions and to confirm my eligibility to work in the United States.

I agree to notify the employer promptly of any change in my name, address, immigration status, or employment authorization that may affect the H‑1B registration or petition.

Applicant initials to confirm understanding and consent:

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