H-1B Departmental Application Request Form

H-1B Departmental Application Request Form

College of Engineering 6-26-2023
This is a request for:*

New EmploymentContinuation of previously approved employment without change with the same employerChange in previously approved employmentChange of employerAmended petition
H-1B Applicant Name*

First NameLast Name
H-1B Applicant Email*
example@example.com
H-1B Applicant Birthdate*

MonthDayYear
Date
Supervisor Name*

First NameLast Name
Supervisor Title*
Supervisor Phone Number*
Supervisor Email*
example@example.com
Position Information
Position Number*
Position Title*
Pay Grade*
University Offered Salary*
FTE Percentage*
Will you be using the "Salary Scale based on 2080 Annual Hours (2.0% Scale)"?*

YesNo
Please provide the information below if you answered “no” to the question: Will you be using the Salary Scale based on 2080 Annual Hours (2.0% Scale) for the University of Kentucky?
Source*
On (date), there are (number) (jobTitle) employed by this department at the University of Kentucky in Lexington, KY.
Date*

MonthDayYear
Date
Number*
Job Title*
Their salaries range from*
to*
The salaries of individuals holding this position were determined on the basis of a number of factors, including (check all that are applicable)*

Level of educationYears of experience in the fieldSpecific job responsibilitySpecialized knowledgeDegree of independent responsibilityNature of the duties involvedOther applicable criteria
If 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, funding recommendations, etc.*
Please list any additional factors that affect the computation of salary. (Other examples might include the size of the group, the specialized nature, and the financial significant of the area worked in or managed.)
Is the salary adjusted based on annual or periodic basis?*

AnnualPeriodic
Is the salary adjusted based on performance evaluations or cost of living?*

Performance evaluationsCost of livingBothNeither
Is a hybrid or remote component included?

YesNo
City*
State*
Requested Employment Start Date*

MonthDayYear
Date
Requested Employment End Date*

MonthDayYear
Date
Name of the Hiring Unit*
The number of employee s the H-1B employee will supervise (excluding student workers)*
Full Office/ Lab Address where the H-1B employee will work
Street Address*
(Example: 512 Administration Drive)
Building Name*
(Example: FPAT)
Office/ Lab Number*
City*
State*
Zip*
Education/ Experience Information
Minimum Degree Requirement*
Academic Field of Degree Required for Position*
Is experience required for this position?*

YesNo
Provide those requirements here (Years/Months):*
Can any of the experience be gained through an educational program?*

YesNo
Provide those requirements here:*
Is additional training required to perform this job outside of the degree training?*

YesNo
Provide those requirements here:*
Are there any other requirements for the position not listed above (i.e. required license / certification, knowledge of a type of equipment, etc.)?*

YesNo
Provide those requirements here:*
JV Information
Name of Dept./ Division Head*

First NameLast Name
Email of Dept./ Division Head*
example@example.com
Account Number (for JV Billing)*
Type of Service*

$1591 - New H-1B$1591 - H-1B Extensions and Amendments
Any additional notes/ considerations for the H-1B application
Should be Empty: