Employee Questionnaire for H-1B Visa Petition

Instructions

Please remit the information requested below. This information will be submitted to our legal department. Thereafter, one of our attorneys will send you a customized questionnaire with a list of required documentation from our "INSZOOM" software system, which you will need to complete and submit to our office in order to proceed further.

Documents Required

Employment Contract or Offer Letter;
Copy of your Passport with visas and entry/exit stamp(s);
Copy of your Form I-94;
Copy of ALL Form I-20 (both sides) and EAD (if you are on a F-1 or F-2 status);
Copy of ALL Form I-797 Approval Notices for nonimmigrant status including (H-1B/H-4, L-1/L-2, TN/TD, E-1/E-2, E-3, etc);
Copy of I-140 Approval notice(s) (if applicable)
J-1/J-2 documentation (DS 2019 and any other related documents and/or waivers) (if applicable);
urrent pay stub(s);
Copies of experience letters, resume and state professional license (if applicable);
Copies of ALL degrees (both front and back), certificates, diploma(s) and transcripts;
Education and/or education/experience evaluation (if applicable)

Joseph Kallabat & Associates, P.C.
7031 Orchard Lake Road, Suite 302
West Bloomfield, MI 48322
Tel (248) 865-3331 - Fax (248) 865-3323

Family Name
Given Name (First Name)
Full Middle Name
Name of H-1B Sponsoring Employer
H-1B Sponsoring Employer's Email Address
Home Phone
Work Phone
Cell Phone
Email Address
Date of Birth (mm/dd/yyyy)
U.S. Social Security
Alien #
Employment Authorization Document # (if any)
SEVIS # (if any)
Country of Birth
Province of Birth
Country of Citizenship
Date of Last Arrival in the U.S. (mm/dd/yyyy)
I-94 # (Arrival/Departure Document)
Current Nonimmigrant Status
Date Status Expires (mm/dd/yyyy)
Passport Number
Date Passport Issued (mm/dd/yyyy)
Date Passport Expires (mm/dd/yyyy)
Current U.S. Address
Foreign Address (Number, Street, City, Town, State ZIP, Country)
U.S. Consulate closest to Person’s foreign address
Do you have a valid passport?
Are you in removal proceedings?
Has a Permanent Residency Labor Certification Application ever been filed for you?
Has an I-140 ever been filed for you?
Within the past seven years, have you ever been given any H or L visa classification? If so, please provide the validity dates for each petition:
Within the past seven years, have you ever been denied any H or L visa classification?
List ALL (prior and current) periods of stay in H-1 or L-1 classification in the United States. Be sure to list only those periods in which you were actually physically present in the United States in an H-1 or L-1 classification. If lengthy, please indicate that you will submit this information with your documents.

Spouse and Dependents Information

If you would like to file for an H-4 visa or would like to extend the H-4 status of your spouse and/or children, please complete the H-4 questionnaire listed in our website under the Questionnaires category. If the H-4 Questionnaire is not completed, our office will not be able to process the necessary paperwork to complete that application. It is the H-4 visa holder's responsibility to ensure that they are maintaining their status in the United States at all times.

Terms of Engagement – Representation

Joseph Kallabat & Associates, PC (hereafter “JK&A”) will solely represent your Employer in connection with the requested H-1B immigration services (the Services). Please review the below information and by submitting the questionnaire you have no objections to JK&A’s representation of your Employer in connection with the Services.

The I-129 nonimmigrant petition is an Employer sponsored petition. You desire that JK&A provide the Services in a manner most likely to result in the expeditious issuance of the H-1B nonimmigrant visa on your behalf. Please note JK&A’s obligation to represent and respect the wishes of your Employer is our primary responsibility. JK&A does have a duty to your Employer and any information that is material to the representation of either party will be disclosed accordingly.

There are several issues which you must be aware of concerning JK&A’s representation of your Employer. The first concerns our obligation of confidentiality. Attorneys are under a duty not to disclose to anyone any information disclosed by a client to the attorney in confidence. JK&A will not disclose any information that you provide to us in connection with the Services to any third party. However, JK&A’s representation will obligate us to disclose your information that is material information relating to the representation to your Employer without regard to whether such information constitutes a client confidence or secret. Second, at issue in any representation setting is the Attorney’s ability to represent its client with zeal and loyalty, should a conflict arise. There always exist potential areas of conflict in representation situations.

Should an actual conflict between you and your Employer arise, JK&A will inform both parties of the feasibility of JK&A’s continued representation. Should JK&A find our continued representation is in both parties interest, we will, after full disclosure, continue your representation. JK&A’s main consideration will be whether we can, in fact, zealously represent both parties without compromising our loyalties to either. Yet, should a dispute be such that the parties decide to litigate, by agreeing to the terms listed here, you allow JK&A to choose to continue representation of your Employer without your prior consent should we so choose. Any information we have obtained during this representation, whether confidential or not, can be disclosed by us.

Additionally, please authorize our office to access your I-94 & travel history records from the following link: https://i94.cbp.dhs.gov/I94/#/home. By clicking "YES", you are providing us authorization to access your records. By accessing this website, you understand and acknowledge that: You are declaring under penalty of perjury pursuant to 28 U.S. Code � 1746 that you: (1) are only seeking records about yourself, (2) are seeking records about someone for whom you are the legal guardian, or (3) you have the consent of the person whose records you are seeking. You are not authorized to access this website to retrieve records of another person unless you are the person's legal guardian or you have the person's consent.

By submitting the H-1B questionnaire you acknowledge that you understand the potential advantages and disadvantages of this representation, and that you have decided to proceed with this representation. You hereby waive your right to disqualify JK&A from representing your Employer in other immigration matters.

I have read and agree to the Terms of Engagement - Representation

What is the result of below calculation?