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
SchoolMajorDegreeYearsGraduated
High School
University/College  
University/College

Employment
Job TitleEmployerDurationSalary ($)
Current Job
Responsibilities    
Job TitleEmployerDuration
Previous Jobs

Certifications

If you have been offered a job in the US, please provide:

Job TitleEmployerIndustrySalary 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?
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