James Louski - Avocat en Immigration - Québec - Canada

ASSESSMENT QUESTIONNAIRE FOR U.S. IMMIGRATION

WARNING: In order to have your assessment the most accurate, please fill in entirely the questionnaire. If a question does not apply to you, answer N/A. Furthermore, enter dates as in the following example: January 12 1996.

General Questions

Are you looking for permanent or temporary residency? Permanent Temporary

Where in the U.S. would you prefer to reside?

Do you have any family members currently residing in the United States?

Your Information

Last Name:

First Name:

Birthdate:

Nationality:

Sex:

Marital Status:

Place of Birth: (Town/Village, State/Province, Country)

U.S. Social Security No. (If any):

Home Phone:

Email address:

Business Phone:

U.S Address (if any) Zip:

Address Abroad (Home)

Cellular Phone Number:
Fax Number:

Education

High School: College: University

Degrees Earned

Year(s) Completed Education (University) (High School)

Any professional licenses, certifications, or professional memberships?

Visa Information

Have you ever been in the United States before?

Type of Visa:

Date/Place of last arrival in U.S

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 until Visa classification

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

Visa Classification

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

Have you ever filed for Permanent Residence in the U.S.?

If yes, give date and place of filing:

Passport Information

What is your Passport No

Passport Issue Date

Passport Expiration Date

Employment

Employment for the last five years. (Present employment first)

Name/Address/Occupation	Salary (US $)	From(mo/yr)	To(mo/yr)>

Addresses

Resident address for the last five years. (Present address first)

Street Address/Apt.	#City/State/Zip	Country	From(mo/yr)	To(mo/yr)

Last address outside of U.S. of more than one year.

Membership

List ALL present/past membership in groups of any kind (Ex.: political party, union, etc...):

Group Name	Location (City/State)	From(mo/yr)	To(mo/yr)

Security Information

Have you ever committed a crime? been arrested been granted pardon?

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 office purposes 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?

Been arrested, cited, charged, indicted, fined or imprisoned for breaking a law, excluding traffic violations?

Been the recipient of an act of clemency or similar action?

Exercised diplomatic immunity to avoid prosecution in U.S.?

Received public assistance in U.S. from any source, or likely to in the future?

Engaged in prostitution in past 10 years, or likely to in future?

Engaged in unlawful commercialized vice such as illegal gambling?

Encouraged any alien to enter U.S. illegally?

Trafficked in any controlled substance?

Been in any way involved in any terrorist activity?

Engaged in espionage or intend to once in the U.S.?

Been a member of or affiliated with the Communist Party?

Engaged in genocide or persecuted any person because of race, religion, national origin or political opinion?

Been deported or excluded from the U.S.?

Committed fraud in order to obtain entry into the U.S.?

Left the U.S. to avoid being drafted into the U.S. Army?

Been a J nonimmigrant visitor and not complied with the 2-year foreign residence requirement or obtained a waiver?

Withheld custody of a U.S. citizen child from a person granted custody of the child?

Been a polygamist or plan to practice polygamy in the U.S.?

Claimed to be a U.S. citizen?

If answered YES to any of the above, explain fully :

Your Family Information

Father's Last Name:

Father's First Name:

Father's Place of Birth: (Town/Village, State/Province, Country)

Father's Date of Birth Deceased Year

Mother's Last Name: Mother's First Name: Mother's Maiden Name

Mother's Place of Birth: (Town/Village, State/Province, Country)

Mother's Date of Birth Deceased Year

Were any of your grandparents born in the U.S.? If so, where

Your Marital Status:

Date of Marriage:

Spouse's Last Name: Spouse's First Name: Spouse's Maiden Name

Spouse's Place of Birth: (Town/Village, State/Province, Country)

Spouse's Date of Birth Citizenship

Spouse's U.S. Social Security No. (if any) Date/Place of Marriage

Former Spouse Last Name: Former Spouse First Name:

Former Spouse Maiden Name

Former Spouse Place of Birth: (Town/Village, State/Province, Country)

Former Spouse Date of Birth Citizenship

Date of Termination of Marriage or Death Where?

Children Information

Children 1 Name Relationship

Children 1 Date of Birth Place of Birth( Town, State, Country)

Children 1 Address (if different)

Children 2 Name Relationship

Children 2 Date of Birth Place of Birth( Town, State, Country)

Children 2 Address (if different)

Children 3 Name Relationship

Children 3 Date of Birth Place of Birth( Town, State, Country)

Children 3 Address (if different)

Children 4 Name Relationship

Children 4 Date of Birth Place of Birth( Town, State, Country)

Children 4 Address (if different)

This web site is designed for general information only. The information presented at this site should not be construed to be formal legal advice nor the formation of a lawyer/client relationship. Persons accessing this site are encouraged to seek independent counsel for advice regarding their individual legal immigration assessment.