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H-1B Temporary Worker Application isss@temple.edu www.temple.edu/isss Form Revised 08/11

203B 1700 N Broad Street (062-57) Philadelphia PA 19122-3429

TEL (215) 204-7708 FAX (215) 204-6166

Department should mail a complete application the following to ISSS (No documents should be emailed). Incomplete applications will be returned to the department. Please note that Temple University is the “petitioner” and the employee is the “beneficiary.” Additionally, we do not provide H-1B sponsorship for part-time employees. This includes Adjunct Faculty. Items Needed For A Complete H-1B Application:

This H-1B Application including the Controlled Technology Form Required Fees. ISSS WILL NO LONGER BE REQUESTING CHECKS.

Use this address for Request for Payment for checks made payable to both USCIS and DHS: US Citizenship and Immigration Services ATTN: H-1B Cap Exempt Services California Service Center 24000 Avila Road, 2nd FL, Rm 2302 Laguna Niguel, CA 92677

Temple University Employment Offer letter signed by appropriate TU Official Official position description that was used in the posting of the position Copies of beneficiary’s passport (passport photo page, US entry stamps, visa stamps, renewal pages only) Copy of both sides of beneficiary’s recent I-94 card issued at a US Border Beneficiary’s Current CV Copy of any license needed for this position Copies of 3 most recent paychecks to establish current employment in the US ONLY

Additional Documents Needed for Employees Who Have Never Worked at Temple University in H-1B Status:

English-language translations of all diplomas Copies of all Forms I-20, DS-2019 and EAD cards Copies of all previous USCIS Approval Notices, including J waiver notice if applicable

Additional Documents Needed for Healthcare Providers Engaging in Clinical Activities:

Copy of the H-1B Applicant’s Resident Physician Rotation Schedule H-1B Applicant’s USMLE Score Reports, Steps 1, 2 and 3 (if applicable) H-1B Applicant’s ECFMG Certification (if applicable)

Additional Documents Needed for Dependents Who Are Currently in the US:

Check for $290 made payable to USCIS Form I-539 (should be completed and signed by dependent, not H-1B Applicant) Copies of Marriage/Birth Certificates Copies of dependents’ immigration documents (passport photo page, US entry stamps, visa stamps, renewal pages

only, Forms I-20 / DS-2019, etc) Make certain that all copies are LEGIBLE!

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APPLICATION PROCESS: 1. Department submits this application and required documents to ISSS

2. Upon determination that the higher of either the prevailing or actual wage is being paid to the

employee, ISSS sends to Human Resources a request to post information regarding the position (this is not a posting for recruitment purposes)

3. ISSS sends Deemed Export Attestation Form and accompanying documents to University Counsel. This

form is required for every H that is submitted, regardless of whether research is involved. Please note that confirmation that no controlled technology license is needed is unpredictable. This process is dependent upon the nature of the position and the research technologies involved.

4. Once HR confirms the LCA posting notice, ISSS submits the Labor Condition Application (LCA) to

Department of Labor (DOL) for certification. Approval for an LCA takes a minimum of seven working days.

5. Once University Counsel notifies ISSS that no Deemed Export License is required for the H-1B

Applicant’s position and the LCA has been certified by DOL, ISSS begins processing the I-129 and supporting letter for the H-1B petition. This step of the process may take two or three business days.

6. When the application process is complete, the H-1B petition is compiled, checks are attached and the

petition is submitted to the United States Citizenship and Immigration Service (USCIS) via UPS. Your department may choose to expedite the USCIS processing of the H-1B petition. The cost for Premium Processing is $1225; this fee is not required. This is in addition to the required $325 Application Fee. The $500 Anti-Fraud fee is required for initial and transfer petitions only. Please note that Premium Processing does not expedite the Labor Condition Application (LCA) process or the Deemed Export Control License decision, but rather only to the adjudication of the Petition for Nonimmigrant Worker (Form I-129) by the USCIS. The response from USCIS can be an approval notice, a request for further evidence, or an intent to deny the petition.

7. The hiring department, Human Resources and the H-1B applicant will be notified via email when ISSS

receives the Receipt Notice and Approval Notice from USCIS.

N.B.: 1. ISSS may take up to 45 days to complete the processing of the materials for this petition 2. Missing information will cause delays in processing of the petition for H status 3. Submission of a petition to the USCIS does not guarantee approval of the petition 4. The Premium Processing fee does not expedite the Labor Condition Application (LCA) process; that

fee applies only to the adjudication of the Petition for Nonimmigrant Worker (Form I-129) by the USCIS

5. The hiring unit must notify ISSS at least 30 days in advance of changes in any conditions of employment so that ISSS can determine if notification to the proper government agency is required

It is extremely important that the department not misrepresent any fact or situational development. In the event that Temple University is audited by the DOL, USCIS or other local, state, or federal agency, ISSS is not responsible for any misinformation provided by the hiring department.

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Information Pertaining To the Position:

Department Name

Departmental UPS Account # (MUST BE LISTED HERE)

Department Contact Name

Phone # Email

Second Dept Contact Name

Phone # Email

Name of H-1B Applicant

H-1B’s Prospective Job Title: Is this a Union Position? Yes No

Budget source (who will pay the H-1B’s salary?)

Temple University Temple University Hospital Temple University Physicians Other:

EIN (Tax) #:

Field in Which the H-1B Applicant Will Work Biological / Biomedical Sciences Biochemistry Microbiology Physics Chemistry Electrical Engineering Mechanical Engineering Other

Hours Per Week

# Years Experience Required For Position (Not # of Years’ Experience Individual Holds)

Salary

per hour per month per year

Degree the Job Requires (Not degrees individual processes)

List any Special Requirements Including Licensure or certification List any supervisory duties required (limit to people applicant can Hire or Fire) Requested H-1B start date

Requested H-1B end date ISSS can request up to 3 years. To avoid cost for return transportation due to loss of funding, only request dates for which you have funding

Action Requested

New employment in H-1B Status Extension Without Changes in Position (Holds H status already) Transfer From Another Institution/Employer (Holds H status already) Change in previously approved employment (Holds H status already) Employment for an H-1B Who will continue to work for another Employer at the same

time as Temple employment All Complete Addresses Where H-1B Will Work - Include ANY worksite during the time period requested in this application

General work schedule (e.g., 9:00 a.m. to 5:00 p.m., Monday through Friday)

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Actual Wage Determination Worksheet H-1B Specialty Occupation Employment

This worksheet is to be completed and signed by the college or department business administrator, or any

other college or department employee responsible for employment matters.

*Note that grant availability may not influence the determination of the actual wage.

The purpose of this document is to report in writing the wage rate levels paid to all personnel holding the position in question with this college or department at the time the H-1B worker in question is offered employment. This worksheet will be made available to the Department of Labor and the Citizenship and Immigration Services in inspection folders, as required, at the Department of Human Resources. Job Title:

EMPLOYEE NAME HIGHEST DEGREE

YEARS OF EXP

SPECIAL SKILLS/KNOWLEDGE/DUTIES

WORKER SUPERVISION

DUTIES

HOURS/ WEEK

WORK MONTHS (9 OR 12)

ANNUAL SALARY

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Use the following section to explain wage-level differences not based on information listed above: I hereby certify that the position and employee information listed above is accurate to the best of my knowledge. Printed Name Signature Date

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Actual Wage Memorandum Federal regulations require that the employer retain documentation specifying the basis it used to establish the actual wage, i.e. how the wage for the H-1B worker relates to the wages paid other individuals with similar experience and qualifications for the specific employment at the place of employment. Please complete this form, then print out and attach appropriate signatures Today’s Date:

# of People Who Hold Same Job Title As H-1B Applicant:

Name of Position H-1B will hold:

Hiring Dept Name:

Address of Hiring Dept:

Salary Range of Employees In This Position:

The salaries of individuals holding this position were determined on the basis of a number of factors, including: (check the criteria that apply in this case plus add any other factors that your department used to determine these salaries):

level of education years of experience in the field specific job responsibility specialized knowledge degree of independent responsibility nature of the duties involved and other applicable criteria ________________________________________________

(Include criteria that are specifically relevant to the position in question, such as knowledge of and/or experience in specific software programs for computer systems analysts, or knowledge of and/or experience in specific financial modeling tools for financial analysts, etc.) Salaries of employees are adjusted on an annual periodic basis, based upon performance reviews

cost of living adjustments other __________________________. Please note that the employer applies the same methodology to all US and H-1B employees in this classification when determining the actual wage, based upon the above referenced criterion. Name of Department Administrator

Signature

Date

$ to $

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Wage Rate Memorandum Please complete this form, then print out and attach appropriate signatures MEMORANDUM TO: International Student and Scholar Services

RE:

(Name of H-1B applicant) DATE:

This is to confirm that as of __________________________ (requested start date of H-1B),

__________________________ (name of H-1B Applicant) will be paid

$_______________(salary) per _______________ (year/month/hour) for his/her service in

the position of _________________ (position title).

Name of Business Administrator:

Signature:

Date:

CERTIFICATION REGARDING THE RELEASE OF CONTROLLED TECHNOLOGY OR TECHNICAL DATA TO FOREIGN PERSONS IN THE UNITED STATES

Prior to filing of any H-1B temporary worker petition, this certification must be completed and signed by the lead investigator/supervisor and department administrator. This information is necessary to assure compliance with federal regulations. PLEASE NOTE: (1) This form requests information regarding the research projects, if any, and related equipment and materials to be

used by the employee, and the employee’s Visa application cannot be approved without this information; (2) You must notify International Student and Scholar Services if the funding source or work assignment of the employee

changes at any time following submission of this form.

EMPLOYEE First Name Family Name/Surname Department

Position or Title at Temple University Country of Citizenship / Permanent Residency

LEAD INVESTIGATOR/SUPERVISOR First Name Family Name/Surname Phone / Email Position or Title at Temple University

DEPARTMENT ADMINISTRATOR First Name Family Name/Surname Phone / Email

PLEASE ANSWER THE FOLLOWING QUESTIONS. ATTACH EXTRA PAGES AS NECESSARY.

1. Will the employee be involved in research? Yes No

(If “Yes,” provide description of research projects. If “No”, skip to Question #5)

2. What is/are the source(s) of funds supporting the research?

Temple Government Industry Other (describe)

3. Will the employee’s job duties involve projects or collaborations that –

a. Restrict participation in the project based on country of origin or citizenship? Yes No

b. Allow only US citizens to participate? Yes No

c. Grant the sponsor the right to review publications in advance of submission? Yes No

(If “Yes”, provide exact language or copy of provision on a separate page.)

d. Limit publication or dissemination of the research results in any manner? Yes No

(If “Yes”, provide exact language or copy of provision on a separate page.)

e. Provide that any part of the sponsoring, granting, or resulting documents not be disclosed?

Yes No

f. Limit access to proprietary or export-controlled technology or data –

(i) Provided by a sponsor or research collaborator? Yes No

(ii) Previously developed by Temple? Yes No

(iii) In Temple’s possession? Yes No

(iv) Produced as part of the project or collaboration? Yes No

(If “Yes” to any part of 3(f) above, please answer the following. Otherwise, skip to Question #3(j).)

g. Is the information clearly identified as proprietary or export-controlled? Yes No

h. Can the information be appropriately protected? Yes No

i. Can controlled information be used in isolated tasks so that the employee can participate in part of the research that is not controlled?

Yes No

(If the answer to (g), (h), or (i) is “No,” please contact University Counsel.)

j. Involve research providing access to source code for encrypted software (other than publicly available software distributed at no charge)?

Yes No

k. Involve research, information or software that could be used for military applications?

Yes No

l. Involve research, information or software that could be used in development of weapons of mass destruction (nuclear, biological, chemical) or their delivery systems?

Yes No

4. For research funded solely by Temple, does the university intend to withhold the research results for proprietary reasons and not share broadly in the scientific community?

Yes No

5. Please provide a list of any scientific equipment, including highly specialized computing equipment, that the employee will use in the course of performing his/her duties.

Yes No

6. Will the employee need to understand how a particular piece of equipment is designed, manufactured, or repaired in order to perform his/her duties?

Yes No

7. Will the employee be exposed to equipment that was specifically designed or developed for military or outer space applications?

Yes No

(If “Yes,” please describe.)

SIGNATURE OF LEAD INVESTIGATOR/SUPERVISOR

SIGNATURE OF DEPARTMENT ADMINISTRATOR

FOR INTERNAL USE ONLY

Received by ISSS ___/___/___ Received by Univ Counsel ___/___/___ Reviewed by Univ Counsel ___/___/___

The employee will ONLY have access to information which is generally accessible or will be generally accessible to the public. A license is not required from either the U.S. Department of Commerce or the U.S. Department of State to release such technology or technical data to the foreign person.

A license is required from the U.S. Department of Commerce and/or the U.S. Department of State to release such technology or technical data to the employee and the investigator will prevent access to the controlled technology or technical data by the beneficiary until and unless the investigator has received the required license or other authorization to release it to the employee.

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DECLARATION OF THE DEPARTMENT Name of Hiring Department Name of the H-1B Applicant The Department Chair and the Supervisor of this H-1B applicant agree to comply with the following regulations during the H-1B application process and during the employment of the H-1B applicant. The department will comply with the following regulations during the H-1B application process and during the employment of the above-named foreign national under the terms of the H-1B status. The hiring department understands and accepts that: • Hiring this foreign national will not adversely affect the working conditions of other workers employed by the department. Additionally there is no strike, lockout, or other labor disputes in the occupation • Department agrees to pay “required wage” • Department has allocated funds to cover the salary of the employee for the duration of his/her employment under the terms of this petition. The employee is eligible for all benefits available to other similarly situated employees. For the duration of this status, Department will not place the employee in an unpaid status, unless ISSS determines that the situation is consistent with U.S. immigration law. • Department agrees to notify the ISSS in advance if the terms of the employment will change IN ANY WAY during the validity period of this H-1B petition so an amended petition can be filed with USCIS. • Department agrees to pay the reasonable costs of the foreign national’s return trip to his/her home country should department terminate his/her employment before the expiration of the employment approved by USCIS. • Department authorizes the ISSS to sign the official DOL and USCIS paperwork required for this petition.

There are time restrictions under which ISSS operates. Delays are expected during seasonal peaks or, at any time, due to unforeseen delays at the state or federal DOL or with USCIS. By submitting this application to ISSS, the department acknowledges the possibility of delays and accepts the impact delays may have on the application or applicant.

Name of Dept Chair Signature

Name of Supervisor Signature

Date

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FEES: Effective August 1, 2010, consistent with the federal regulations found at 20 CFR 655.731(c)(9)(iii)(C), University departments hiring individuals in Nonimmigrant Worker (H-1B) status are required to pay mandatory processing fees associated with such employment. Specifically, hiring departments are required to pay and cannot pass along to the prospective employee(s) the current US$500.00 “anti-fraud” fee (required for new employees) and the current US$325.00 routine processing fee (required for all employees). The hiring department must pay the US$1,225.00 premium processing fee if the purpose of Premium Processing is to allow the H-1B to begin work in a timely manner. If the H-1B wishes to file with Premium Processing (for travel purposes, etc), the employee can be asked to pay that fee. Hiring departments may also choose, but are not required, to pay the current $290.00 fee for applications of dependents of employees in H-1B status. Please note that the Premium Processing Fee does not expedite the Labor Condition Application (LCA) process; that fee applies only to the adjudication of the Petition for Nonimmigrant Worker (Form I-129) by the USCIS.

PAYEE AMOUNT Required? PURPOSE WHO MUST PAY US Department of Homeland Security US$ 500.00 For Initial and

Transfer H-1B ONLY Anti-fraud Fee Hiring Department

US Citizenship and Immigration

Services US$ 325.00

Always Required Routine H-1B processing fee

Hiring Department

US Citizenship and Immigration

Services

US$ 1,225.00

Optional Premium processing fee

Hiring Department unless H applicant

is traveling, etc US Citizenship and

Immigration Services

US$290.00 Only if Dependents are

in US Dependent I-539 fee Either Dept or H-1B

Dependents: Dependents who are outside the US: All dependents who plan to enter the US in H-4 status must apply for H-4 visa stamps at a US Consulate outside the US. Please visit the Consulate’s website at http://usembassy.state.gov/ for items needed to apply for the H4 visa. Do not complete a Form I-539 for Dependents who are not currently holding a non-immigrant status (i.e.H-4, J-2, F-2, etc) in the US. Dependents who are currently holding H-4 status or another non-immigrant status in the US (i.e. J-2, F-2, etc): All dependents of the applicant who are already in the US and need to extend H-4 status or change status to H4 must complete and sign a Form I-539 available online at www.uscis.gov The fee for Form I-539 is $290, regardless of the number of applicants. If more than one Dependent of the H-1 applicant is applying for H-4 status, the eldest dependent (usually the spouse) should complete and sign the application and the additional dependents should be listed on Supplement-1. If all Dependents applying for H-4 status are minors (under the age of 18 years), the oldest child should sign the I-539 in Part 5 if s/he is 14 years old or older. If the dependent filing the form is younger than 14 years old, the applicant should sign Part 5 AND Part 6, Signature of person preparing form, if other than above, indicating “Parent of Minor”. Dependent family members in H-4 status are NOT eligible to work but may study full or part time. Children 21 years of age and older are NOT eligible for H-4 status. See first page of this form for check list of items needed for Dependents BE AWARE OF CHECK ISSUE-DATES TO ENSURE THEY DO NOT EXPIRE DURING THE APPLICATION PROCESS!

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Information Pertaining To the H-1B Applicant:

Family Name (Last Name)

Given Name (First Name) Full Middle Name

All Other Names Used (include aliases maiden name and names from all previous marriages) Date of Birth (mm/dd/yyyy)

Gender Male Female

U.S. Social Security # A Number (if any) A-

Country of Birth

Province of Birth Country of Citizenship

If in the United States, Complete the Following: Date of Last Arrival (mm/dd/yyyy)

I-94 # (Arrival/Departure Document) Current Nonimmigrant Status

Date Status Expires (mm/dd/yyyy) or D/S

Student & Exchange Visitor Information System (SEVIS) #(if any)

Employment Authorization Document (EAD) Number (if any)

Passport Number

Date Passport Issued (mm/dd/yyyy) Date Passport Expires (mm/dd/yyyy)

Current U.S. Address (if applicable) Email Address:

TU ID #

US Phone #:

Phone # Abroad:

Is H-1B currently Outside the US? Already in the US? If applicant is in the US, will s/he travel outside the US within the next six months? Yes No If yes, please list tentative plans for travel: In which status did applicant last enter the U.S.?

What status does applicant hold now?

Will Any Dependents Be Included With This Petition? Yes No (Only include dependents that are inside the US)

Highest Degree Received

Degree is in what field of study?

If the H-1B Applicant is outside the United States or if a requested extension of stay or change of status cannot be granted, state the U.S. consulate or inspection facility you want notified if this petition is approved. THIS SECTION MUST BE COMPLETED. Type of Office (Check one): Consulate Pre-flight inspection Port of Entry Office Address (City) U.S. State or Foreign Country Beneficiary's Foreign Address

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Has Applicant ever held H-1B status before? Yes No Submit Copies of All Previously-Issued Approval Notices Does Applicant have any H-1B petitions pending with USCIS? Yes No If yes, what is the name of the employer? How was the petition filed?

Initial H1-B Extension/Amendment H-1B Concurrent H-1B Provide ISSS a copy of the completed and signed Form I-129 and the Labor Condition Application (LCA) used to file the I-129 for any non-Temple-sponsored H-1B petition plus all previously-issued receipt/approval notices Has applicant applied for a green card? Yes No If yes, on which basis:

Employment-based Family-based National Interest Waiver DV Lottery Asylum Other

Submit copies of PERM App, I-140 and I-485 Receipt and Approval Notices with Application

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CERTIFICATE OF AUTHENTICITY OF ATTACHED DOCUMENTS By submitting this application, you declare that all copies of documents submitted to ISSS are exact photocopies of unaltered original documents and that you understand that you may be required to present the original documents during any subsequent contacts with the U.S. Citizenship and Immigration Services or the Consular Service. Name of H-1B Applicant:

Date:

Signature

List all prior periods of stay in ALL NON-IMMIGRANT CLASSIFICATIONS. Be sure to list only those periods in which you were physically present in the U.S. Status Begin Date Status End Date Comments

Check the answer below that best describes your situation (you must check one):

I have never held J-1 Exchange Visitor status I have held J-1 Exchange Visitor status but I have never been subject I have held J-1 Exchange Visitor status and I received a waiver [provide copy of Form I-612] I have held J-1 Exchange Visitor status and I fulfilled the requirement by returning to my country of

permanent residence for 2 years. Please check the option below which best describes your situation:

I am currently outside the US. I understand that I must wait for ISSS to mail me the original approval notification from USCIS. I know that I will need to schedule an appointment at a US Consulate to apply for an H-1B visa stamp unless I am from a visa-exempt country. Upon entry into the US, I must meet with ISSS within 5 days of my arrival into the US.

I am currently in a nonimmigrant status other than F-1 or H-1B. I am aware that I must receive confirmation of approval of the H-1B petition before I can begin employment at Temple University/Temple University Health Systems.

I am currently in the US holding H-1B status and working for an employer other than Temple University/Temple University Health Systems. I understand that I should not resign from my current position until HR notifies my department that I may begin working at TU/TUHS as ISSS has received the H-1B Receipt Notice from USCIS.

I am currently in F-1 status working on Post-Completion Optional Practical Training. I understand this if the H-1B petition is not approved before my EAD expires, I may not begin working at Temple University/must be removed from Payroll until my department is notified by ISSS that the H-1B petition is approved and my department has been notified by HR that I may begin working under the auspices of the H-1B petition.

If none of the above apply to you, please explain your situation below: