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H-1B Application Information Form

*Required fields


Last Name *  

First Name * 

Middle Name  

Date of Birth *  

Email *

Current Mailing Address

Street Address *


City *

State/Province/Region *

ZIP/Postal Code *

Country *

Foreign Address

Street Address

ZIP/Postal Code
Phone (work) 
Phone (mobile) *  
Country of Birth *  
Country of Citizenship *  
State/Province of Birth *  
City of Birth *  
Passport Number *  
Date Passport Issued   
Date Passport Expires *     
Issuing Country *  
If you are a new employee at WFBMC, please provide the estimated start date of your employment.  
Position Title for WFBMC Job    
Sponsoring WFBMC Department  
Base salary you will be receiving from WFBMC (exclusive of bonuses, incentives, etc.)   
Brief summary of position duties
(2-4 sentences maximum)

Are you currently in the U.S.?


Do you have any dependents who will be included in your H-1B application?

If yes, you will need to complete Form I-539 and submit it to International Services so that it can be submitted with the H-1 petition. Please be aware that this is considered a personal application and is not associated with WFBMC. 
Are you, or any person included in the H-1B application, an applicant for an immigrant visa or adjustment of status to permanent residence? *   
Has an immigrant petition ever been filed for you or any other person included in the H-1B application?
Have you or any other person included in the H-1B petition ever been convicted of a criminal offense since last entering the U.S.?
Have you or any person listed in the H-1B application ever done anything that violated the terms of the nonimmigrant status you presently hold?
Are you currently classified as an H-1B nonimmigrant? *  
Are you currently residing in the U.S. in J-1/J-2 status, or have you ever held this status in the past?
Are you currently employed in the U.S. in H-1B status by an employer other than WFBMC?
Name of WFBMC department with which you are/will be working *
If you will be applying for an H-1 visa outside of the U.S., please provide the location of the U.S. Embassy/Consulate where you will be scheduling your visa interview.

Any questions related to the H-1 petition process should be address to Pam Melton:

Quick Reference

Pamela Melton
Program Manager


M-F, 10 am - 5 pm
Office of International Services
Wake Forest Baptist Medical Center
Medical Center Blvd.
Winston-Salem, NC 27407
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