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All information contained in the Immigration Consultation Form will be kept STRICTLY CONFIDENTIAL.

INFORMATION ABOUT YOU
 Name

 Last:       First:    Middle: 

 Other names used (including maiden name):    Sex:  

 E-mail address:     

Current Address in U.S.
Number and Street:
City: State:    Zip: 
Last Address Outside of U.S.
Number and Street:
City:    State/Province:     Postal Code: 
Country:
Home Phone:
Hours we can call:
Fax Number:
Work Phone:
Hours we can call:
Pager/Cell Phone: 
Social Security No:
Citizen of:
Date and Place of Birth:
Date of Birth:
City or Town:
State or Province:
Country:
Passport Information:
Passport Country:
Passport Number:
Expiration Date:
 
 What type of immigration assistance are you seeking?

 
FAMILY INFORMATION
Husband or Wife             In the U.S. ,Yes Outside of U.S. ,No Unmarried ,Unmarried
Spouse's Name
Last:       First:     Middle: 


Other names used (including maiden name):
Current Address (put "same" if you live together):

 
Date and Place of Birth:
Date and Place of Marriage:
Citizen of:
Applying with you?
Social Security Number:
Alien ("A") Number:
Immigration Status:
Expiration Date:
 Children

 Total Number of Sons and Daughters:

Name Sex Date & Country

of Birth		 Citizen of Immigration

  Status		 Expiration

Date		 Applying

with You?
 Parents

Name Country of Birth Citizen of Immigration Status
Your

Father:
Your

Mother*:
Spouse's

Father:
Spouse's

Mother*:
* Use Mother's Maiden Name
 Previous Marriages              (

Check if Not Applicable)

Name

 Date of

Marriage		 Country of

Marriage

Kids?

 Reason for

Termination

of Marriage		 Date of

Termination

of Marriage		 Country of

Termination

of Marriage
Your's:
Spouse's:
IMMIGRATION HISTORY
Current Immigration Status:

 Date Status Expires:

 Alien ("A") Number:
Date of First Entry into U.S.:

 Last Entry into U.S.:

 I-94 Number:
 Check every type of immigration status that you have ever held and provide the dates:

Immigration Status Date(s) Immigration Status Date(s)
B :  Visitor E  Trader/Investor :
F  Student : H-1B  Professional :
J Exchange Visitor: K Fiancee:
L Manager: O  Outstanding Ability:
T/N  Canadian Worker:  Other:
 Check each one that you or your spouse have ever applied for or been the beneficiary of:

Y(you) or

S(Spouse)		 Date Filed  Sponsor  Attorney  Result
Green Card
Immigrant petition
Labor certification
Asylum
Amnesty

 Have you or your spouse ever had any immigration problems? In particular, have you or your spouse ever been under removal,

 deportation, or  exclusion proceedings? Please describe in detail:  

 
EMPLOYMENT HISTORY
 Current Employer (or Employer Petitioning on Your Behalf)

Employer:
Address:
Job Title:     Salary:
Date of Hire:
Are you related to your employer?

  May we contact your employer?



 If yes, whom may we contact:

Name Title Department Phone Number
 Employment in Last Five Years (anywhere in the world)

Job Title Employer Country Duration
 JOB QUALIFICATIONS

 List the professional licenses or certifications you possess, from any state or country:

 

 How many years of experience do you have in your position or field?
EDUCATIONAL BACKGROUND
 Please list all your education anywhere in the world:

Level School/Country Degree & Major Number of

   Years		 Graduate?
College/University:
College/University:
Other Schooling:
OTHER INFORMATION
Have you ever been arrested or convicted of a crime anywhere in the world (even if the conviction was expunged or removed from your record) or have you ever had any problems with the police?



If yes, please explain in detail:

Have you ever claimed to be a citizen of the United States or have you ever used another name

for immigration purposes or for any other reason?



If yes, please explain in detail:

Have you ever been denied a visa to come to the United States?



If yes, when and what kind of visa:

During what years, if any, have you filed an Income Tax Return with the IRS?

If you ever had an Employment Authorization Card issued by the INS, give number(s) and validity dates:

Is there anything, not already covered in this form, that you feel we should know?

STATEMENT OF TRUTHFULNESS


"By pressing the Send Questionnaire button below,

I certify that I have read and understood the instructions above this questionnaire.

I certify that all of the information contained in this form is true and correct to the best of my knowledge."





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