Any information obtained from this questionnaire will be kept completely confidential. INFORMATION REGARDING THE APPLICANT (i.e. the person seeking the immigration benefit): Name * First Name Last Name Email Sex * Male Female Date of Birth MM DD YYYY Phone Number (###) ### #### Current Address Address 1 Address 2 City State/Province Zip/Postal Code Country Country of Birth Citizenship(s) Have you ever been arrested inside or outside the United States? If so, please explain when, where, and what the outcome was. VISA INFORMATION Have you ever been granted a visa before? Yes No If you have been granted a visa before, please list the visa(s) you have been granted, along with all the dates you were physically present in the U.S. with that visa: Example: H-1B: October 1, 2018 - present F-1: January 1, 2015 - October 1, 2018 Are you currently in the United States? * If yes, please answer the following questions. If no, please skip to the next section. Yes No If you are currently in the U.S., what is your immigration status? What visa category did you enter the U.S. with (i.e. Visa Waiver, B-1/B-2, F-1, H-1B, L-1, O-1, Lawful Permanent Resident, Entered Without Documentation, etc.) If you are currently in the U.S., what was the date of your most recent arrival? MM DD YYYY If you are currently in the U.S., what is the date your I-94 status expires? Please visit http://i94.cbp.dhs.gov to obtain your I-94 information. MM DD YYYY Please describe any questions you may have received by Customs and Border Protection upon your entry into the United States. Please provide, to the best of your knowledge, all other times you have entered the U.S. From (month/day/year) - To (month/day/year) Are you currently facing any immigration deadlines (i.e. need to respond to an RFE or denial; your visa/I-94 status is expiring; court dates; aging out for benefits; etc.)? If so, please explain and include any deadline dates. APPLICANT'S EDUCATION Please provide a list of all of your degrees/fields, date you graduated (month/year), and name of school you attended APPLICANT'S CURRENT EMPLOYMENT Name of current employer Present Occupation FAMILY Do you have a spouse or children who are present in the United States or will accompany you to the United States? Yes No Please list the full name and current immigration status for any spouse or children Example: Jon Smith, H-4 INFORMATION REGARDING THE EMPLOYER (i.e. the company seeking to sponsor the immigrant): Full Legal Business Name Name of Employer's Point of Contact First Name Last Name Job Title of Employer's Point of Contact Email of Employer's Point of Contact Phone of Employer's Point of Contact (###) ### #### Current Number of Employees Business Address Address 1 Address 2 City State/Province Zip/Postal Code Country Description of what the company does, including products and/or services it offers, customer information, how the company does what it does, and who and who it sell its products/services to. JOB OFFER Job Title Annual Salary $ Intended Start Date MM DD YYYY Description of the job duties to be performed, the skills used, and the qualifications required to perform the duties Is there any additional information you would like to provide on your situation? Thank you!
