US H-1B Visa Application Form
Employer's Version

Please enter the following information if you would like www.USADiversityLottery.com to apply for a H-1B visa for your company. our immigration Attorney will contact you as soon as your information has been reviewed.

* = required fields
About Your Company
Name
Telephone
Fax
Address
Zip Code
Company homepage
Contact Name*
Contact's Position
Contact Telephone
Contact e-mail*
Federal Employer/IRS Tax ID No.
% of employees in H-1B status
About The Job
Job Title
Minimum educational requirements
Salary (inc. benefits)
Job location (if different from above)
Have you tried to advertise the Job (H-1B Dependent Employers) Yes No
If Yes, please give details
Job Title
About the Candidate
First Name
Middle Name
Last (Family) Name
Gender Male Female
Email:
Contact phone #
Date of Birth
Nationality:
Qualifications
Work Experience
Have they held a previous US work permit? Yes No
If Yes, please give details
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