H1B VISA DEPARTMENT REQUEST FORM
Supervisor’s First Name Requestor’s Title: Supervisor’s Last Name Supervisor’s Extension
Department:
Division / College:
H!B Applicants Name:
Job Title:
Proposed Date of Hire:
No
Salary per Year:
Yes
Full or Part time Status:
Member of Bargaining Unit (check appropriate box):
Country of Citizenship:
Supervisor’s Signature
Date:
Current Immigration Status: TN Visa F1 J1 OPT Card Never worked in the US before H1B If currently on an H1B Visa: H1B currently issued to (name of organization): ____________________________________ List ALL prior visas, types and duration: Current H1B expires on: _________________
Visa Request: Renewal of Current Visa issued to UT New Visa or Transfer from Prior Employer
Visa Length Requested: One year Visa starting on: ____________ Three year Visa starting on: __________
Please note: Per the USCIS if an employee on an H1B Visa is terminated before the end of their visa, the organization will be required to pay for the employee to return to their home country. This means that the department will be responsible for all costs associated with returning the terminated employee back to their home country.