Consular Electronic Application Center - Print Application - HHY3 2018¶
Source:
/Volumes/X9 Pro/ObsNotes/YoudaoYunNotes/HHY-2017-Online Nonimmigrant Visa Application (DS-160).note.attach/Consular Electronic Application Center - Print Application - HHY3 2018.pdfConverted: 2025-12-10 12:17:10
9/7/2018 Consular Electronic Application Center - Print Application
https://ceac.state.gov/GenNIV/common/printapplication.aspx?jFNTCP46UYabDvh2ZzeLQ%2bVN0lWrhF9hHqpUGc%2bo6Tk%3d 1/6
Online Nonimmigrant Visa Application (DS-160)
Application - Sensitive But Unclassified(SBU)
We do not need a printed copy of your application at any point during your interview process. Only print this
application if you want a copy for your own records. If you print your application, please keep it secure.
Photo Provided:
Confirmation Number:
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: ZHANGZHOU, 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
Are you a permanent resident of a country/region other than your
country/region of origin (nationality) above?
YES
Other Permanent Resident Country/Region (1): CANADA
National Identification Number: 120104197409026813
U.S. Social Security Number: 858983669
U.S. Taxpayer ID Number: DOES NOT APPLY
Home Address: 2863 WATERFRONT DRIVE
City: MONUMENT
State/Province: COLORADO
Postal Zone/ZIP Code: 80132
Your Personal Copy -- Do Not Bring to Interview
9/7/2018 Consular Electronic Application Center - Print Application
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Your Personal Copy -- Do Not Bring to Interview
Country/Region: UNITED STATES OF AMERICA
Same Mailing Address? YES
Primary Phone Number: 0017192082858
Secondary Phone Number: 008618612039763
Work Phone Number: 0017195314215
Email Address: hhy@agilent.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): INTRACOMPANY TRANSFEREE (L)
Specify: INTRACOMPANY TRANSFEREE (L1)
Application Receipt/Petition Number: WAC1605051476
Have you made specific travel plans? NO
Intended Date of Arrival: 27 OCTOBER 2018
Intended Length of Stay in U.S.: 3 YEAR(S)
Address where you will stay in the U.S.: 2863 WATERFRONT DR
Person/Entity Paying for Your Trip: U.S. PETITIONER
Are there other persons traveling with you? NO
Have you ever been in the U.S.? YES
Date Arrived (1): 29 FEBRUARY 2016
Length of Stay: 12 MONTH(S)
Date Arrived (2): 08 MARCH 2017
Length of Stay: 4 MONTH(S)
Date Arrived (3): 04 JULY 2017
Length of Stay: 2 MONTH(S)
Date Arrived (4): 13 SEPTEMBER 2017
Length of Stay: 4 MONTH(S)
Date Arrived (5): 25 JANUARY 2018
Length of Stay: 9 MONTH(S)
Do you or did you hold a U.S. Driver's License? YES
Driver's License Number (1): 07-170-0343
State of Driver's License: COLORADO
Your Personal Copy -- Do Not Bring to Interview
9/7/2018 Consular Electronic Application Center - Print Application
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Your Personal Copy -- Do Not Bring to Interview
Have you ever been issued a U.S. Visa? YES
Date Last Visa was Issued: 17 JANUARY 2018
Visa Number: M4789982
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?
YES
Explain: FRAGOMEN REPRESENTING MY EMPLOYER FILED I-
140 IMMIGRANT PETITION ON BEHALF RECEIPT#
LIN1690907169
U.S. Contact Information
Contact Person Name in the U.S.: MOON, TRAVIS
Organization Name in the U.S.: AGILENT TECHNOLOGIES INC
Relationship to You: U.S. PETITIONER
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.?YES
Relative Name (1): HUANG, ZIYUN
Relationship to you: CHILD
Status: NONIMMIGRANT
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
Your Personal Copy -- Do Not Bring to Interview
9/7/2018 Consular Electronic Application Center - Print Application
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Your Personal Copy -- Do Not Bring to Interview
Address: 1902 GARDEN OF THE GODS
City: COLORADO SPRINGS
State/Province: COLORADO
Postal Zone/Zip Code: 80907
Country/Region: UNITED STATES OF AMERICA
Work Phone Number: 7195314215
Monthly Salary in Local Currency (if employed): 9691
Briefly Describe your Duties: MANAGE THE DESIGN AND IMPLEMENTATION OF
BUSINESS-CRITICAL IT INFRASTRUCTURE. ENGAGE
CUSTOMERS TO DEFINE AND DOCUMENT BUSINESS
REQUIREMENTS, PROVIDE CONSULTATION AND
COORDINATE SOLUTION & ARCHITECTURE DESIGN,
MANAGE SOLUTION DEPLOYMENT THROUGH 3RD
PARTY VENDORS
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 MAY 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/regions within the last five years? YES
Provide a List of Countries/Regions Visited
Country/Region (1): GERMANY
Country/Region (2): CANADA
Country/Region (3): SWITZERLAND
Your Personal Copy -- Do Not Bring to Interview
9/7/2018 Consular Electronic Application Center - Print Application
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Your Personal Copy -- Do Not Bring to Interview
Country/Region (4): KENYA
Country/Region (5): 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, such as 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
Your Personal Copy -- Do Not Bring to Interview
9/7/2018 Consular Electronic Application Center - Print Application
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Your Personal Copy -- Do Not Bring to Interview
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
Are you a former exchange visitor (J) who has not yet fulfilled the two-year foreign residence requirement? 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
Temporary Work Visa Information
Application Receipt/Petition Number: WAC1605051476
Name of Person/Company who Filed Petition: AGILENT TECHNOLOGIES INC
Where Do You Intend to Work?
Name of Employer: AGILENT TECHNOLOGIES INC
Street Address: 1902 GARDEN OF THE GODS RD
COLORADO SPRINGS, COLORADO 80907
Phone Number: 7195314074
Monthly Income (in USD): $9,691
Location Information
Location where you will be submitting your application
Current Location: BEIJING, CHINA
Preparer of Application
Did anyone assist you in filling out this application? NO
Your Personal Copy -- Do Not Bring to Interview
您已于 在您的申请表格上进行了电子签名。 07-Sep-2018 05:46:37 (GMT-05:00). 除非按规定您被豁免，否则您需要在申请表格上电子签名。即使
您的表格不是自己，而是由别人代为准备的。您的电子签名证明：您已经阅读并了解申请表格中的问题，您的回答是尽您所知的真实及正确的回答。任何
虚假或误导性的陈述都可能导致永久性拒签，或被拒绝入境美国。按照做伪证要受处罚的条例（ 28 U.S.C.1746) ，申请表中所有声明都只是一种没有进
行宣誓的声明。
关于您在申请时提交的表格以及其它文件中提供的信息，都可能为具有司法授权的其它政府部门使用，包括法律实施及执行移民法等目的。如果录入您的
指纹是您签证审理程序的一部分，那末您的指纹可能会用来与联邦调查局新一代的指纹识别系统（ NGI ）或其继任系统（包括其它民事、刑事及潜指纹
库）里的指纹进行对比。您在申请表格中提供的照片也可能用来确认就业或其它涉及美国法律的目的。