General Immigration Questionnaire

I. IDENTIFICATION INFORMATION

Name:

Other names:

Sex:

Male
Female

Date of birth:

Place of birth:

Citizenship:

U.S. Social Security No.

A#

USCIS Online Account No.:

he Location 12.

Permanent address abroad:

E-Mail:

Telephone:

Facsimile:

U.S. address:

Telephone:

Facsimile:

If in the U.S., complete the following:

Date of arrival:

I-94 No.:

Current nonimmigrant status:

Expires:

Place where last entered U.S.:

Means of travel into U.S.:

Did you talk with a Border or Pre-Flight Inspector on entry into U.S.?

Passport No.:

Date issued:

Date expires:

Marks of identification:

Father’s name:

Date of birth:

Place of birth:

Residence:

Mother’s name:

Date of birth:

Place of birth:

Residence:

Were any of your or your spouse’s grandparents born in the United States?

Yes
No

If so, when?

Are either you or your spouse an American Indian born in Canada of at least 50 percent Native bloodline?

Yes
No

Are either you or your spouse eligible for a Native American tribal document?

Yes
No

II. MARITAL INFORMATION

Marital status:

Will spouse accompany you to U.S.?

Yes
No

Spouse’s Name:

Spouse former spouse name

Country of citizenship

Date of Divorce/Death

Married previously?

Yes
No

Your second former spouse’s name:

III. LIST PRESENT BROTHERS, SISTERS AND CHILDREN, INCLUDING STEPCHILDREN

Name (First, Last)

Relationship and DOB

City/State/Country of Birth/Address

Applying with you and Immig Status

Do you have any children who are within four years of the age of 21 who may eventually want to live permanently in the U.S.?

Yes
No

IV. RESIDENCES LAST FIVE YEARS (present address first)

Street Address/Apt. #

City/State/Country

Zip / Postal

From-To/Present

V. PRESENT/PAST MEMBERSHIP IN GROUPS OF ANY KIND, INCLUDING MILITARY, SINCE YOUR 16th BIRTHDAY (if more space is required, use back of sheet)

Group Name

City/State

From (Mo/Yr)

To (Mo/Yr)

VI. INFORMATION REGARDING U.S. EMPLOYER

Company name:

Address:

Type of business:

Occupation:

Start Date:

Date company established:

IRS Tax No.:

No. of employees:

Annual Income:

Gross $

Net $

Position full-time?

Yes
No

Number of hours per week:

Wages per week: $

Other compensation?

Value: $

Company contact:

Telephone:

Facsimile:

VII. POSITION OFFERED IN THE U.S.

Job title:

Job duties:

Location of place of employment:

Work Schedule

Name of labor union:

Minimum education/degree required to perform the job duties:

Field of study:

Do other persons with your job have this education/degree?

Yes
No

Special requirements/skills needed to perform the position (i.e., knowledge of certain types of computer software, foreign language, etc.):

Minimum years of experience required to perform the job duties:

Title of immediate supervisor:

Number of people you will supervise:

VIII. EDUCATION

School Name/Address

Field of Study

From-To

Degree

List professional licenses:

IX. PRIOR WORK EXPERIENCE
(if additional space is required, use back of sheet)

Present Employer:

Address:

Employed:

Job title:

Job duties:

Employer:

Address:

Employed:

Job title:

Job duties:

Employer:

Address:

Employed:

Job title:

Job duties:

Last occupation abroad:

Employer:

Address:

Employed:

Job title:

Job duties:

X. IMMIGRATION-RELATED QUESTIONS

Ever applied for a U.S. nonimmigrant visa before?

Yes
No

Has your U.S. visa ever been canceled?

Yes
No

Plan to apply for immigrant visa abroad?

Yes
No

Plan to adjust status in U.S.?

Yes
No

XI. GROUNDS OF EXCLUSION

1. Have you ever in or outside the United States:

a. Knowingly committed any crime of moral turpitude or a drug-related offense for which you have not been arrested?

Yes
No

b. Been arrested, cited, charged, indicted, fined or imprisoned for breaking or violating any law or ordinance, excluding traffic violations?

Yes
No

c. Been the beneficiary of a pardon, amnesty, rehabilitation decree, other act of clemency or similar action?

Yes
No

d. Exercised diplomatic immunity to avoid prosecution for a criminal offense?

Yes
No

If you answered YES to any of the above, give the following information:

Date

Place (City, State, Country)

Nature of Offense

Outcome

Date

General Immigration Questionnaire

I. IDENTIFICATION INFORMATION

II. MARITAL INFORMATION

III. LIST PRESENT BROTHERS, SISTERS AND CHILDREN, INCLUDING STEPCHILDREN

IV. RESIDENCES LAST FIVE YEARS (present address first)

V. PRESENT/PAST MEMBERSHIP IN GROUPS OF ANY KIND, INCLUDING MILITARY, SINCE YOUR 16th BIRTHDAY (if more space is required, use back of sheet)

VI. INFORMATION REGARDING U.S. EMPLOYER

VII. POSITION OFFERED IN THE U.S.

VIII. EDUCATION

IX. PRIOR WORK EXPERIENCE (if additional space is required, use back of sheet)

X. IMMIGRATION-RELATED QUESTIONS

XI. GROUNDS OF EXCLUSION

If you answered YES to any of the above, give the following information:

IX. PRIOR WORK EXPERIENCE
(if additional space is required, use back of sheet)