General Questionnaire For Immigration Consultations

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

	City, State of Birth

	Country of Birth

	Address (if different)

	U.S. Soc. Sec. No.

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