Form A - UCI International Center

UCI International Center
H1‐B Checklist for Prospective Employees
Date of birth:
Month: Day: Year:
Full Name:
Current Visa status:
Relationship to you:
Country of Citizenship:
Country of birth:
Date of birth:
Month: Day: Year:
Full Name:
Current Visa status:
Relationship to you:
Country of Citizenship:
Country of birth:
Date of birth:
Month: Day: Year:
Current Visa status:
UCI International Center • Irvine, CA 92697‐5255 • P: 949.824.7249 • F: 949.824.3090 • intl@uci.edu • www.ic.uci.edu
IC Office Use Only: Date Received: Advisor’s Initials: Ready for Pick‐Up On: | Revised On 7.25.2014