Consultation
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.       Outside of U.S.        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 all of the information contained in this form is true
and correct to the best of my knowledge."



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