H1b Biodata Form Page 4
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______________________
______________________
______________________
LAST/FAMILY NAME
First/Given Name
Middle
______________________
______________________
______________________
Date of Birth (MM/DD/YYYY)
City of Birth
Country of Birth
______________________
______________________
Son
Daughter
Country of Citizenship
Country of Legal Permanent Residence
Has your child ever been on J-1 or J-2 status?
Yes
No
If yes, has your child been recommended for and/or granted a waiver of the two-year home residency obligation?
Yes
No
If yes, please attach to this form a copy of the waiver recommendation and/or waiver approval.
o
Child
______________________
______________________
______________________
LAST/FAMILY NAME
First/Given Name
Middle
______________________
______________________
______________________
Date of Birth (MM/DD/YYYY)
City of Birth
Country of Birth
______________________
______________________
Son
Daughter
Country of Citizenship
Country of Legal Permanent Residence
Has your child ever been on J-1 or J-2 status?
Yes
No
If yes, has your child been recommended for and/or granted a waiver of the two-year home residency obligation?
Yes
No
o
If yes, please attach to this form a copy of the waiver recommendation and/or waiver approval.
I certify under penalty of perjury that the above information is correct.
___________________________________________
___________________
Signature:
Date:
_________________________________________________________________________
Office of International Affairs
Page 4 of 4
Revised 12/29/2014
G:\2011-2012 OIA SOP F I N A L\5. H-1B H-4 - EMPLOYEES\H-1B BIODATA INFORMATION FORM REVISED 12.29.2014.docx
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