DS-160 - HHY 2014.note¶
Source:
/Volumes/X9 Pro/ObsNotes/YoudaoYunNotes/默认笔记本/DS-160 - HHY 2014.note.pdfConverted: 2025-12-10 12:19:23
Photo Provided:
Confirmation Number:
Your Personal Copy -- Do Not Bring to Interview
Your Personal Copy -- Do Not Bring to Interview
Personal, Address, Phone, and Passport/Travel Document Information
Name Provided: HUANG, HAIYUAN
Full Name in Native Language: 黄海渊
Other Names Used: NO
Telecode Name Used: YES
Telecode Name 7806, 3189 3220
Sex: MALE
Marital Status: MARRIED
Date of Birth: 02 SEPTEMBER 1974
Place of Birth: HUAAN, FUJIAN, CHINA
Country/Region of Origin (Nationality): CHINA
Do you hold or have you held any nationality other than the one
indicated above on nationality? NO
National Identification Number: 120104197409026813
U.S. Social Security Number: DOES NOT APPLY
U.S. Taxpayer ID Number: DOES NOT APPLY
Home Address: RM 1502 APT 2 BUILDING 501
WANGJINGDONGYUANWUQ
U CHAOYANG DIST
City: BEIJING
State/Province: DOES NOT APPLY
Postal Zone/ZIP Code: 100102
Country/Region: CHINA
Same Mailing Address? YES
Primary Phone Number: 008618612039763
Secondary Phone Number: 00861080852378
Work Phone Number: DOES NOT APPLY
Email Address: hhy885@gmail.com
Passport/Travel Document Type: REGULAR
Passport/Travel Document Number: E29737781
Passport Book Number: DOES NOT APPLY
Country/Authority that Issued Passport/Travel Document: CHINA
City Where Issued: BEIJING
Country/Region Where Issued:CHINA
Issuance Date: 16 SEPTEMBER 2014
Expiration Date: 15 SEPTEMBER 2024
Have you ever lost a passport or had one stolen? NO
Travel Information
The List of Purposes of Trip to the U.S.
Purpose of Trip to the U.S. (1):TEMP. BUSINESS PLEASURE
VISITOR (B)
Specify:
BUSINESS & TOURISM
(TEMPORARY VISITOR)
(B1/B2)
Have you made specific travel plans? YES
Provide a complete itinerary for your travel to the U.S.:
Date of Arrival in U.S.: 31 OCTOBER 2014
Arrival Flight: CA989
Arrival City: NEW YORK
Date of Departure from U.S.:08 NOVEMBER 2104
Departure Flight: CA990
Departure City: NEW YORK
The Location(s) you plan to visit in the U.S.
Location (1): NEW YORK
Address where you will stay in the U.S.: 440 W 57TH ST
HOLIDAY INN NEW YORK
City, State, Postal/Zip Code:NEW YORK, NEW YORK
Person/Entity Paying for Your Trip: SELF
Are there other persons traveling with you? YES
Are you traveling as part of a group or organization?NO
Persons Traveling with You:
Name (1): LIN, JINGHUAN
Relationship to You: SPOUSE
Have you ever been in the U.S.? YES
Date Arrived (1): 09 APRIL 2011
Length of Stay: 2 WEEK(S)
Date Arrived (2): 15 JANUARY 2011
Length of Stay: 2 WEEK(S)
Date Arrived (3): 11 JANUARY 2010
Length of Stay: 2 WEEK(S)
Date Arrived (4): 22 JUNE 2008
Length of Stay: 1 WEEK(S)
Date Arrived (5): 20 MAY 2007
Length of Stay: 2 WEEK(S)
Do you or did you hold a U.S. Driver's License? NO
Have you ever been issued a U.S. Visa? YES
Date Last Visa was Issued: 30 DECEMBER 2010
Visa Number: C9543036
Are you applying for the same
type of visa? YES
Are you applying in the same
country where the visa above is
issued and is this country your
principal country of residence?
YES
Have you been ten-printed?YES
Has your U.S. Visa ever been
lost or stolen? NO
Has your U.S. Visa ever been
cancelled or revoked? NO
Have you ever been refused a U.S. Visa, or been refused
admission to the United States, or withdrawn your application for
admission at the port of entry?
NO
Has anyone ever filed an immigrant petition on your behalf with
the United States Citizenship and Immigration Services?NO
U.S. Contact Information
Contact Person Name in the U.S.: MOON, TRAVIS
Organization Name in the U.S.: AGILENT TECHNOLOGIES
Relationship to You: EMPLOYER
U.S. Contact Address: 1900 GARDEN OF THE GODS
ROAD
COLORADO SPRINGS,
COLORADO 80907
Phone Number: 7195902074
Email Address: travis_moon@agilent.com
Family Information
Father's Surnames: HUANG
Father's Given Names: FEICHANG
Father's Date of Birth: DO NOT KNOW
Is your father in the U.S.? NO
Mother's Surnames: LIN
Mother's Given Names: XIULIAN
Mother's Date of Birth: DO NOT KNOW
Is your mother in the U.S.? NO
Do you have any immediate relatives, not including parents in the
U.S.? NO
Do you have any other relatives in the United States?NO
Spouse's Full Name: LIN, JINGHUAN
Spouse's Date of Birth: 15 SEPTEMBER 1973
Spouse's Country/Region of Origin (Nationality): CHINA
Spouse's City of Birth: JILIN
Spouse's Country/Region of Birth: CHINA
Spouse’s Address: SAME AS HOME ADDRESS
Work/Education/Training Information
Primary Occupation: COMPUTER SCIENCE
Present Employer or School Name: AGILENT TECHNOLOGIES
CO LTD
Address: NO 3 WANG JING BEI LU
CHAOYANG DIST
City: BEIJING
State/Province: DOES NOT APPLY
Postal Zone/Zip Code: 100102
Country/Region: CHINA
Work Phone Number: 861064397888
Monthly Salary in Local Currency (if employed): 30447
Briefly Describe your Duties:
WORKING WITH IT GROUPS
IN IMPLEMENTING IT
INFRASTRUCTURE
STRATEGIES. RESPONSIBLE
FOR LEADING DESIGN,
PLANNING, AND
IMPLEMENTATION WHILE
ENSURING THE
INFRASTRUCTURE
SOLUTION IS COST
EFFECTIVE AND MEETS THE
REQUIREMENTS.
ACCOUNTABLE FOR
ONGOING SERVICE
PLANNING, AVAILABILITY,
ESCALATIONS, COSTING
AND PROJECT
MANAGEMENT.
Were you previously employed? NO
Have you attended any educational institutions at a secondary
level or above? YES
Name of Institution (1): TSINGHUA UNISVERSITY
Address of Institution: TSINGHUA UNISVERSITY
HAIDIAN DISTRICT
City: BEIJING
State/Province: DOES NOT APPLY
Postal Zone/ZIP Code: 100084
Country/Region: CHINA
Course of Study: BUSINESS ADMINISTRATION
Date of Attendance From:01 SEPTEMBER 1999
Date of Attendance To: 30 JUNE 2001
Name of Institution (2): NANKAI UNIVERSITY
Address of Institution: NO 94 WEI JIN LU
City: TIANJIN
State/Province: DOES NOT APPLY
Postal Zone/ZIP Code: 300071
Country/Region: CHINA
Course of Study: INFORMATION SYSTEM
Date of Attendance From:01 SEPTEMBER 1991
Date of Attendance To: 30 JUNE 1995
Do you belong to a clan or tribe? NO
Provide a List of Languages You Speak:
Language Name: (1): CHINESE
Language Name: (2): ENGLISH
Have you traveled to any countries within the last five years?YES
Country/Region Visited (1): SWITZERLAND
Country/Region Visited (2): KENYA
Country/Region Visited (3): KOREA, REPUBLIC OF
(SOUTH)
Country/Region Visited (4): UNITED STATES OF AMERICA
Have you belonged to, contributed to, or worked for any
professional, social, or charitable organization? NO
Do you have any specialized skills or training, including firearms,
explosives, nuclear, biological, or chemical experience?NO
Have you ever served in the military? NO
Have you ever served in, been a member of, or been involved
with a paramilitary unit, vigilante unit, rebel group, guerrilla group,
or insurgent organization?
NO
Security and Background Information
Do you have a communicable disease of public health
significance? (Communicable diseases of public significance
include chancroid, gonorrhea, granuloma inguinale, infectious
leprosy, lymphogranuloma venereum, infectious stage syphilis,
active tuberculosis, and others diseases as determined by the
Department of Health and Human Services.)
NO
Do you have a mental or physical disorder that poses or is likely
to pose a threat to the safety or welfare of yourself or others?NO
Are you or have you ever been a drug abuser or addict?NO
Have you ever been arrested or convicted for any offense or
crime, even though subject of a pardon, amnesty, or other similar
action?
NO
Have you ever violated, or engaged in a conspiracy to violate,
any law relating to controlled substances? NO
Are you coming to the United States to engage in prostitution or
unlawful commercialized vice or have you been engaged in
prostitution or procuring prostitutes within the past 10 years?
NO
Have you ever been involved in, or do you seek to engage in,
money laundering? NO
Have you ever committed or conspired to commit a human
trafficking offense in the United States or outside the United
States?
NO
Are you the spouse, son, or daughter of an individual who has
committed or conspired to commit a human trafficking offense in
the United States or outside the United States and have you
within the last five years, knowingly benefited from the trafficking
activities?
NO
Have you knowingly aided, abetted, assisted or colluded with an
individual who has committed or conspired to commit a severe
human trafficking offense in the United States or outside the
United States?
NO
Do you seek to engage in espionage, sabotage, export control
violations, or any other illegal activity while in the United States?NO
Do you seek to engage in terrorist activities while in the United
States or have you ever engaged in terrorist activities?NO
Have you ever or do you intend to provide financial assistance or
other support to terrorists or terrorist organizations?NO
Are you a member or representative of a terrorist organization?NO
Have you ever ordered, incited, committed, assisted, or otherwise
participated in genocide? NO
Have you ever committed, ordered, incited, assisted, or otherwise
participated in torture? NO
Have you committed, ordered, incited, assisted, or otherwise
participated in extrajudicial killings, political killings, or other acts
of violence?
NO
Have you ever engaged in the recruitment or the use of the child
soldiers? NO
Have you, while serving as a government official, been
responsible for or directly carried out, at any time, particularly
severe violations of religious freedom?
NO
Have you ever been directly involved in the establishment or
enforcement of the population controls forcing a woman to
undergo an abortion against her free choice or a man or a woman
to undergo sterilization against his or her free will?
NO
Have you ever been directly involved in the coercive
transplantation of human organs or bodily tissue? NO
Have you ever been the subject of a removal or deportation
hearing? NO
Have you ever sought to obtain or assist others to obtain a visa,
entry into the United States, or any other United States
immigration benefit by fraud or willful misrepresentation or other
unlawful means?
NO
Have you failed to attend a hearing on removability or
inadmissibility within the last five years? NO
Have you ever been unlawfully present, overstayed the amount of
time granted by an immigration official or otherwise violated the
terms of a U.S. visa?
NO
Have you ever withheld custody of a U.S. citizen child outside the
United States from a person granted legal custody by a U.S.
court?
NO
Have you voted in the United States in violation of any law or
regulation? NO
Have you ever renounced United States citizenship for the
purpose of avoiding taxation? NO
Have you attended a public elementary school on student (F)
status or a public secondary school after November 30, 1996
without reimbursing the school?
NO
Location Information
Location where you will be submitting your application
Current Location: GUANGZHOU, CHINA
Preparer of Application
Did anyone assist you in filling out this application?NO
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