HR H-1B Review Form

HR H-1B Review Form

Personal Information

Full legal name:

Date of birth:    Country of citizenship:

Passport number:    Passport expiration date:

Position & Employment Information

Proposed start date:    Expected weekly hours:

Wage Determination & LCA

Prevailing wage amount:    Wage source (employer determination):

LCA filing date (if already filed):    LCA case number:

The employer attests that the wage offered meets or exceeds the required prevailing wage for the occupation and that the terms and conditions of employment are not adverse to similarly employed U.S. workers. The information provided in this form will be used to prepare the Labor Condition Application and H-1B petition. Any material misstatement may result in denial or withdrawal of petition and disciplinary action.

Immigration & Background Information

Status expiration date (if applicable):    Last date of U.S. entry:

  I have been previously the beneficiary of one or more H-1B petitions (approved, denied, or withdrawn).

  I have had a prior petition denied, revoked, or withdrawn by USCIS. If checked, explain below.

  I have been convicted of or plead guilty/no contest to a crime, or have immigration violations. If checked, describe below.

Education & Qualifications

Is a foreign degree credential evaluation required?

Attach transcripts, diplomas, evaluations, professional licenses as required for qualification review. Indicate attachments in the intake packet checklist (submitted to HR).

Employment History (Most Recent)

Start date:    End date:

Start date:    End date:

References

Legal Disclosures & Authorizations

At-Will Employment: Employment with the company is at-will unless otherwise set forth in a signed written employment agreement. Nothing in this immigration sponsorship process alters the at-will employment relationship.

Equal Employment Opportunity: The employer evaluates all candidates without regard to race, color, religion, sex, national origin, disability, age, or other protected status. Sponsorship decisions are made consistent with applicable nondiscrimination requirements.

  I authorize the company and its authorized representatives to contact my previous employers, educational institutions, and licensing authorities and to obtain any background, education, employment, or credential verification necessary to support the H-1B petition.

  I authorize the company to conduct criminal background checks, immigration-history verification, and other pre-employment checks required for immigration compliance and employment eligibility determinations.

Applicant Certification

I certify under penalty of disciplinary action up to and including termination that the information provided on this form is complete, true, and accurate to the best of my knowledge. I understand that any material misstatement or omission may result in denial of the H-1B petition, withdrawal of sponsorship, and/or disciplinary action by the employer. I will promptly notify the employer of any changes in my immigration status or material changes to the facts set out in this form.

I acknowledge that the employer will rely on this information to prepare immigration filings and LCA documentation, and I agree to cooperate in providing documentary evidence and executing required immigration forms and attestations.

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