H1b Biodata Form Page 2
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4J Exchange Visitor Information:
Have you ever been in the U.S. on J-1 or J-2 visa status?
Yes
No
If yes, please attach to this form a chronological listing of all previous Exchange Visitor training, to include
begin date, departure date, status (e.g. Researcher , Student, Trainee, etc.), program sponsor(s), and name(s)
of training institution(s) with legible copies of all DS-2019 or IAP-66 forms issued to you and/or your
dependents.
If yes, were you sponsored by the Educational Commission for Foreign Medical Graduates (ECFMG)?
Yes
No
If yes, were/are you subject to the 2-year home residency requirement?
Yes
No
If yes, have you applied for a waiver of the 2-year home residency requirement?
Yes
No
o
o
If yes, please explain using the space below on what grounds did you seek the waiver:
______________________________________________________________________
o
If yes, please use the space below to provide the status and case number of your waiver:
______________________________________________________________________
Status
______________________________________________________________________
Case Number
o
If yes, attach to this form a copy of the waiver recommendation and/or waiver approval.
H Visa Information:
Have you ever been in the U.S. on the “H” classification (e.g. H-1B, H-4, etc.)?
Yes
No
If yes, please provide the information below detailing your previous stay(s) in the U.S.:
Year
Dates you were physically present in U.S. H Visa Status Classification
2015
_________________________________
_________________________
2014
_________________________________
_________________________
2013
_________________________________
_________________________
2012
_________________________________
_________________________
2011
_________________________________
_________________________
2010
_________________________________
_________________________
2009
_________________________________
_________________________
If you were physically present in the U.S. prior to 2009 on the “H” classification, please list all periods of stay below:
__________________________________________________________________________________
__________________________________________________________________________________
If yes, and you were in the U.S. on the H-1B visa, did you depart the U.S. for any length of time during the
approved period of validity?
Yes
No
o
If yes, please use the space below to provide 1) dates of departure from the U.S.; 2) dates of return to
the U.S.; and 3) travel destination outside the U.S. (please attach a separate sheet if needed). You must
also provide legible copies of any documents issued to you and your dependents as evidence of your
departure and return to the U.S.
______________________________________________________________________
______________________________________________________________________
_________________________________________________________________________
Office of International Affairs
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