Adjustment of Status Questionnaire

Please be advised that the Wenger law firm represents the employer company, not the individual foreign national and/or dependants. Thus, any communications between you and any employee or agent of the Wenger law firm may not be protected by the attorney-client privilege. Any information you provide us is not confidential and may be disclosed to our client, the employer company.

Instructions:

Please complete a separate questionnaire for each depandant family member who will be included in the Adjustment of Status application.  Please note that you must complete all information in order to submit the form.  If a question is not applicable, simply input "N/A."  If you do not yet have the required information such as your U.S. address, input "Unknown."  As soon as you have more information, such as your new address, please provide it to us immediately.  If you fail to provide complete answers to any of these questions, processing your application or petition will take significantly longer than we anticipated.

If you need additional space to complete any question, please use the space at the end of the questionnaire marked "Additional Information."  Please indicated the number of the question, for which you are providing the answer in the "Additional Information" section.

Once you have completed the form, please click the "Submit" button.  Please do not mail or fax the completed questionnaire because it will delay the processing of your application.  Thank you.

Personal & Family Information
 
1. Your relationship to Adjustment Applicant
Self
Husband
Wife
Son
Daughter
 
2. Gender
Male
Female
 
3. Your full name (first middle last) exactly as it appears on your passport:
 *
 
4. Aliases (maiden name former names etc...):
 *
 
5. Your place of birth (city state country):
 *
 
6. List all countries of nationality or ctizenship:
 *
 
7. Date of birth (mm/dd/yyyy):
 *
 
8. United States address (street number names city state and zip code where you will reside in the U.S. if known.):
 *
 
9. Address abroad (street number name city province postal code country where you currently reside):
 *
 
10. Current telephone numbers with area code and country code (any home business home fax business fax mobile telephone if applicable):
 *
 
11. Email address (Please advise if this is a secure address where we can send confidential information.):
 *
 
12. Social Security Number (SSN) if any:
 *
 
13. Alien Number (A#) if any:
 *
 
14. National Identification Number if any:
 *
 
15. Marital status (single married widowed estranged or separated divorced)
 *
 
15. Spouse's full name (first middle last) exactly as it appears on their passport:
 *
 
16. Spouse's Aliases (maiden name former names etc...):
 *
 
17. Spouse's date of birth (mm/dd/yyyy):
 *
 
18. Name age and gender of all dependant children:
 *
 
19. Are any of the following people currently residing in the United States (please answer yes or no and check all that apply)?
 *
Husband
Wife
Father
Mother
Finace(e)
Son
Daughter
Brother Sister
 
20. Last residence (complete address) outsite the United States where you resided for at least one year (street number and name / city / state / postal code)
 *
 
20. List the complete address for every residence you've had during the last five (5) years excluding your current address (please list addresses in chonolocial order with the dates you lived there):
 *
 
Immigration & Travel Information
 
21. Do you intend to travel internationally during the next six (6) months? If yes please provide you intended dates of departure destination purpose of travel and the expected length of stay for all such inteded trips abroad:
 *
 
22. Date (mm/dd/yyyy) you were last admitted to the United States.
 *
 
23. Last U.S. port of entry (city state country):
 *
 
24. Classification under which you were last admitted to the United States (e.g. H-1B Visa Waiver Program B1/B2 Visitor E-2)
 *
 
25. Current I-94 number:
 *
 
26. Epiration date of current I-94 (mm/dd/yyyy):
 *
 
27. List all of the countries you visited in the last ten (10) years:
 *
 
28. List all of the countries that ever issued you a passport:
 *
 
29. Place of passport issuanc (city state and country):
 *
 
30. Date of passport issuance (mm/dd/yyyy):
 *
 
31. Passport number:
 *
 
32. Passport expiration date (mm/dd/yyyy):
 *
 
33. Have you ever been denied a U.S. visa for any reason? If so please explain:
 *
 
34. Have you ever had a U.S. visa revoke or cancelled? If so please explain:
 *
 
35. Has anyone ever filed an application for a U.S. immigrant visa on your behalf? If so please explain:
 *
 
36. Have you ever been issued a U.S. visa? If so please provide the following for each U.S. visa (date of issuance expiration date place of issuance and type of visa):
 *
 
37. Have you ever applied for a labor certification immigrant petition (Form I-140) or other form of lawful permanent residency ("green card")? If yes please explain:
 *
 
38. Do you currently have specific travel arrangements to the United States? If yes please provide a detailed itinerary including point of departure and point and date of entry:
 *
 
39. Have you ever had any problems or difficulties with U.S. immigration or American Consulates? If yes please explain:
 *
 
Professional Information
 
42. Name and address of your current employer or school:
 *
 
44. Please provide the: (i) name (ii) address (iii) telephone number (iv) job title (v) supervisor's name and (vi) dates of employment for you last five (5) years:
 *
 
Additional Family Information
 
47. Were you previously married (yes or no)?
 *
 
48. Full name (first middle last) of former spouse:
 *
 
49. Former spouse's date of birth (mm/dd/yyyy):
 *
 
50. Former spouses's birthplace (city state and country):
 *
 
51. Date of marriage to former spouse (mm/dd/yyyy):
 *
 
52. Place of marriage to former spouse (city state and country):
 *
 
53. Date of dissolution of marriage (mm/dd/yyyy):
 *
 
54. Place of dissolution of marriage of former spouse (mm/dd/yyyy):
 *
 
55. Full name of your father (first middle last):
 *
 
56. Your father's date of birth (mm/dd/yyyy):
 *
 
57. Your father's place of birth (city and country):
 *
 
58. Is your father deceased (yes or no)?
 *
58a. If you father is deceased indicate the year of death:
 *
 
59. Full name of your mother (first middle last):
 *
 
60. Your mother's maiden name:
 *
 
61. Your mother's date of birth (mm/dd/yyyy):
 *
 
62. Your mother's place of birth (city and country):
 *
 
63. Is your mother deceased (yes or no)?
 *
63a. If you mother is deceased indicate the year of death:
 *
 
Miscellaneous
 
64. Please list past and present memberships or affiliations with every political organization association fund party club society or similar organization or group in the U.S. and abroad since your 16th birthday. Please include any U.S. or foreign military service. Incude the full name of the organization address dates of membership and the nature of the organization.
 *
 
65. Have you ever knowingly commited any crime of moral turpitude or a drug related offense for which you have not been arrested? If yes please explain:
 *
 
66. Have you ever been arrested cited charged indicted fined or imprisoned for breaking or violating any law or ordinance (excluding minor traffic violations)? If yes please explain:
 *
 
67. Have you ever been the beneficiary of a pardon amnesty rehabilitation decree act of clemency or similar action? If yes please explain:
 *
 
68. Have you ever exercised dipomatic immunity to avoid prosecution for a criminal offense? If yes please explain:
 *
 
69. Have you ever been detained by a police agency or similar government authority or been taken to a police station? If yes please explain:
 *
 
70. Have you ever received public assistance in the United States from any source (excluding emergency medical treatement) or are you likely to receive public assistance in the future? If yes please explain:
 
71. Have you ever within the past ten (10) years been a prostitute or procured anyone for prostitution or intend to engage in such activities in the future? If yes please explain:
 
72. Have you ever engaged in any lawful commecialized vice including but not limited to illegal gambling? If yes please explain:
 *
 
73. Have you ever encouraged induced assisted or aided any alien to try to enter the United States Illegaly? If yes please explain
 *
 
74. Have you ever illicitly trafficked in any controlled substance or knowingly assisted aided abetted or colluded in the illicit trafficking of any controlled substance? If yes please explain:
 *
 
75. Have you ever engaged in conspired to engage in or do you ever intend to engage in or have you ever solicited membership of funds for or have you through any means ever assisted or provided any type of material to support to any person or organization that has been engaged in or conspired to engage in sabotage kidnapping political assasination hijacking or any other form of terrorist activity? If yes please explain:
 *
 
76. Do you intend to engage in espionage in or against the United State? If yes please explain:
 *
 
77. Do you intend to engage in any activity the purpose of which is opposition to or the control or overthrow of the government of the United States by force violence or other unlawful means? If yes please explain?
 *
 
78. Do you intend to engage in any activity to violated or evade any law prohibiting the export from the United States of goods technology or sensitive information? If yes please explain:
 *
 
79. Have you ever been a member of or in any way affiliated with the Communist Party or any other totalitarian party? If yes please explain:
 *
 
80. Di you during the period of March 23 1933 to May 8 1945 in association with either the Nazi government of Germany or any organization or government associated or allied with the Nazi government of Germany ever order incite assist or otherwise participate in the persecution of any person because of race religion national origin or political opinion? If yes please explain:
 *
 
81. Have you ever engaged in genocide or otherwise ordered incited assisted or otherwise participated in the killing of any person because of race religion nationality ethnic origin or political opinion? If yes please explain:
 *
 
82. Have you ever been deported from the United States or removed from the U.S. at government expense excluded within the past year or are now in exclusion or deportation proceedings? If yes please explain:
 *
 
83. Are you under a final order of civil penalty for violating Section 274(c) of the Immigration & Nationality Act for use of fraudulent documents or have you by fraud or willful misrepresentation or a material fact ever sought to procure or procuded a visa other documentation entry into the U.S. or any other immigration benefit? If yes please explain:
 *
 
84. Have you ever left the United States to avoid being drafted into the U.S. armed forces? If yes please explain:
 *
 
85. Have you ever been a J nonimmigrant exchange visitor who was subject to the two (2) year foreign residency requirement and not yet complied with that requirement or obtained a waiver? If yes please explain:
 *
 
86. Are you now withholding custody of a U.S. citizen child outside the United States from any person granted custody to that child? If yes please explain:
 *
 
87. Do you plan to practice polygamy in the United States? If yes please explain:
 *
 
Supporting Documentation
 
Passport: complete copy of passport including blank pages
Court & Prison Records:
Military Records:
Photographs: Eight (8) passport photographs
Security code:
 *
Do not enter anything in this field:

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