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General Questionnaire For Immigration Consultations
 

A. Please email a copy of your resume or curriculum vitae to leon@globalimsa.com after completing this form.
     
  B. What are your immigration goals?
   
  What do you intend to achieve by this immigration process?
   
  Where in the U.S. would you prefer to reside?
   
  C. Do you have any family members currently residing in the United States?
   
  D. YOUR INFORMATION
   
  Last Name
     
  First Name
   
  Middle Name
   
  Maiden Name
   
  Date of Birth (Month/Day/Year)
   
  Nationality (Country)
   
  Citizen of (Country)
   
  Other names used (including maiden name)
   
  Sex Male Female
   
  Place of Birth (Town/Village)
   
  Place of Birth (State/Province)
   
  Place of Birth (Country)
   
  U.S. Social Security No. (if any)
   
  Home Phone
   
  E-mail address
   
  Business Phone
   
  U.S. Address (if any)
   
  Zip
   
  Address Abroad (Home)
   
  Phone Number Abroad
   
  Education: High School
   
  Education: College
   
  Degrees Earned
   
  Year(s) Completed Education (University)
   
  Year(s) Completed Education (High School)
   
  Any professional licenses, certifications, or professional memberships?
   
  Have you ever been in the United States before? yes no
   
  Date of last arrival in U.S (Month/Day/Year)
   
  Place of last arrival in U.S.
   
  Type of Visa?
   
  How long did you stay in the United States?
   
  Has a prior employment visa petition ever been filed on your behalf?
   
  If YES, then answer the following:
   
  Where
   
  When
   
  Approved
   
  Means of travel into U.S.
   
  Inspected
   
  Status at entry (visitor, student)
   
  Consulate Visa Issued
   
  Visa Number
   
  Date Visa Issued
   
  Visa Expiration Date
   
  OR Indefinite yes no
   
  Visa Classification
   
  What is your Passport No.
   
  Passport Issue Date
   
  Passport Expiration Date
   
  If in the U.S., what is your I-94 No.
   
  I-94 Issue Date
   
  I-94 Expiration Date
   
  Duration of Stay
   
  Name Exactly as it appears on I-94
   
  Employment last five years. (Present employment first)
   
 
Name/ Address/ Occupation
Salary
From To
(Mo/Yr) (Mo/Yr)
   
  Resident address for the last five years. (Present address first)
   
 

Street Address/Apt
#City/State/Zip
Country
From To
(Mo/Yr) (Mo/Yr)
   
  Last address outside of U.S. of more than one year.
   
  List ALL present/past membership in groups of any kind:
   
  Group Name
Location (City/State)
From To
(Mo/Yr) (Mo/Yr)
   
  Have you ever filed for Permanent Residence in the U.S.? yes no
   
  If yes, give date and place of filing:
   
  Have you ever committed a crime? yes no
   
  been arrested? yes no
   
  been granted pardon? yes no
   
  If answered YES to any of the above, give the following information:
   
  Date
Place (City/State/Country)
Nature of Offense
Outcome
   
  U.S. Embassies and Consulates are required to run security clearance on every visa applicant. The following questions and your responses are intended for SRT&F only. Your answers will assist us in evaluating your chances of securing a visa and or permanent resident status.
Have you ever:
   
  Committed a crime of moral turpitude
or drug-related offense for which
you were not arrested?		 yes no
   
  Been arrested, cited, charged, indicted, fined or imprisoned for breaking
a law, excluding traffic violations?		 yes no
   
  Been the recipient of an act of clemency or similar action? yes no
   
  Exercised diplomatic immunity to avoid prosecution in U.S.? yes no
   
  Received public assistance in U.S. from any source, or likely to in the future? yes no
   
  Engaged in prostitution in past 10 years, or likely to in future? yes no
   
  Engaged in unlawful commercialized vice such as illegal gambling? yes no
   
  Encouraged any alien to enter U.S. illegally? yes no
   
  Trafficked in any controlled substance? yes no
   
  Been in any way involved in any terrorist activity? yes no
   
  Engaged in espionage or intend to once in the U.S.? yes no
   
  Been a member of or affiliated with the Communist Party? yes no
   
  Engaged in genocide or persecuted any person because of race, religion,
national origin or political opinion?
 yes no
   
  Been deported or excluded from the U.S.? yes no
   
  Committed fraud in order to obtain entry into the U.S.? yes no
   
  Left the U.S. to avoid being drafted into the U.S. Army? yes no
   
  Been a J nonimmigrant visitor and not complied with the 2-year foreign
residence requirement or obtained a waiver?
 yes no
   
  Withheld custody of a U.S. citizen child from a person granted custody of
the child?
 yes no
   
  Been a polygamist or plan to practice polygamy in the U.S.? yes no
   
  Claimed to be a U.S. citizen? yes no
   
  If answered YES to any of the above, explain fully:
   
  D. YOUR FAMILY INFORMATION
   
  Name of Father (Last) (First Name)
   
  Father’s Place of Birth (City, State, Country)
   
  Father’s Date of Birth
   
  Deceased? yes no
   
  Deceased Year
   
  Father’s Residence
   
  Name of Mother (Last, Maiden & First)
   
  Mother’s Place of Birth (City, State, Country)
   
  Mother’s Date of Birth
   
  Deceased? yes no
   
  Deceased Year
   
  Mother’s Residence
   
  Were any of your grandparents born in the U.S.? yes no
   
  If so, where?
   
  Your Marital Status (M/W/D/SP/S)
   
  Date of Marriage
   
  Number of times married, including this marriage
   
  Spouse’s Name (Last, First, Middle & Maiden)
   
  Place of Birth
   
  Spouse’s Date of Birth (Month/Day/Year)
   
  Spouse’s U.S. Social Security No. (if any)
   
  Date/Place of Marriage
   
  Former Spouse’s Name (Last, First, Middle & Maiden)
   
  Former Spouse’s Date of Birth (Month/Day/Year)
   
  Citizenship (Country)
   
  Date of Termination of Marriage or Death
   
  Where?
   
  List children, including stepchildren
   
  1. Name
   
  Relationship
   
  DOB
   
  City, State of Birth
   
  Country of Birth
   
  Address (if different)
   
  U.S. Soc. Sec. No.
   
  2. Name
   
  Relationship
   
  DOB