U.S. Immigration Questionnaire
** Please fill out this questionnaire to the best of your ability.
Correctly filling out this form is required before we can schedule a telephone consultation.
All information provided will be kept strictly confidential. **
PRINCIPAL APPLICANT
Applicant's Full Name
Last Name
*
First Name
*
Middle Name
Maiden Name
General Information
Address
*
City
*
State/Province
Country
*
Home Telephone
*
Work Telephone
Fax
E-Mail Address
Social Security No
Date of Birth
MM
DD
YYYY
Passport Number
Expiration Date
MM
DD
YYYY
Country of Birth
Citizen of
Marital Status
Single
Married
Widowed
Divorced
Separated
Gender
*
Male
Female
Reason for requesting a telephone consultation
*
Education
School
Major
Degree
Years
Graduated
High School
University/College
University/College
Employment
Job Title
Employer
Duration
Salary ($)
Current Job
Responsibilities
Job Title
Employer
Duration
Previous Jobs
Certifications
If you have been offered a job in the US, please provide:
Job Title
Employer
Industry
Salary Offered
Immigration Information
Current Status
Status Expires
MM
DD
YYYY
# Entries into US
First Entry
MM
DD
YYYY
I-94 Number
Last Entry
MM
DD
YYYY
Please list your immigration status and dates for each previous period of stay in the U.S.
Status 1
Date 1
MM
DD
YYYY
Status 2
Date 2
MM
DD
YYYY
Status 3
Date 3
MM
DD
YYYY
Status 4
Date 4
MM
DD
YYYY
Please list all visa petitions that you or your spouse ever had filed on your behalf
Applicant
Attorney
Sponsor
Result
Visa Type
Date Filed
MM
DD
YYYY
Attorney
Sponsor
Result
Visa Type
Date Filed
MM
DD
YYYY
Spouse
Attorney
Sponsor
Result
Visa Type
Date Filed
MM
DD
YYYY
Attorney
Sponsor
Result
Visa Type
Date Filed
MM
DD
YYYY
Please explain below any immigration problems you or your spouse may have ever had.
Family Information
If you don't have a spouse check this box
Spouse
Last Name
First Name
Middle Name
Maiden Name
Country Of Birth
Citizen Of
Gender
Male
Female
Date of Birth
MM
DD
YYYY
Children
How many children do you have?
0
1
2
3
4
5
6
7
Parents
Applicant's Father
Name
Country Of Birth
Citizen Of
Date of Birth
MM
DD
YYYY
Applicant's Mother
Name
Country Of Birth
Citizen Of
Date of Birth
MM
DD
YYYY
Spouse's Father
Name
Country Of Birth
Citizen Of
Date of Birth
MM
DD
YYYY
Spouse's Mother
Name
Country Of Birth
Citizen Of
Date of Birth
MM
DD
YYYY
Past Marriages
Of Applicant
Name
Citizenship
Place of Marriage
Date of Marriage
MM
DD
YYYY
Number of Children
Divorce/Death
MM
DD
YYYY
Name
Citizenship
Place of Marriage
Date of Marriage
MM
DD
YYYY
Number of Children
Divorce/Death
MM
DD
YYYY
Of Current Spouse
Name
Citizenship
Place of Marriage
Date of Marriage
MM
DD
YYYY
Number of Children
Divorce/Death
MM
DD
YYYY
Name
Citizenship
Place of Marriage
Date of Marriage
MM
DD
YYYY
Number of Children
Divorce/Death
MM
DD
YYYY
Miscellaneous Information
If you have ever been arrested or convicted, please explain in detail.
Please explain below if you have ever been denied a visa or refused admission to the United States.
Please list the years during which you have, if ever, filed an Income Tax Return with the IRS.
If you have ever received an Employment Authorization card, please list the numbers and validity dates.
If you have ever written work that was published or the subject of a publication (or other media) please summarize here the number of publications and names of the more significant publications.
If you have ever won a significant award, please list here.
Do you own or work for a business outside of the United States that may open a U.S. office?
Do you own or are you planning to invest in a U.S. business? If so, please describe the nature of the business.
If there is anything else you think we should know, please list here.
I have filled out this questionnaire to the best of my ability
Sign Name
*
:
Today's Date
*
: MM
DD
YYYY