Wenger - Visa Questionnaire

Personal Information

1. Full Name (first middle last):
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2. Aliases (maiden name former names etc...):
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3. Place of Birth (city state country)
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4. Country(ies) of Nationality or Citizenship:
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5. Date of Birth (month / day / year)
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6. United States Address (street number names city state and zip code where you will reside in the U.S. if known.):
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7. Address Abroad (street number name city province postal code country where you currently reside)
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8. Current Telephone Numbers with area code and country code (any home business home fax business fax mobile telephone if applicable.):
*

9. Email address (Please advise if this is a secure address where we can send confidential information.):
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10. Social Security Number (SSN) if any:
*

11. Alien Number (A#) if any:
*

12. National Identification Number if any:
*

13. Marital Status (single married widowed estranged or separated divorced)
*

14. Spouse's Full Name (first middle last):
*

15. Spouse's Aliases (maiden name former names etc...):
*

16. Spouse's Date of Birth (month / day / year):
*

17. Name Age & Sex of All Dependant Children:
*

18. Are any of the following people currently residing in the United States (please answer yes or no and check all that apply)?
*

Spouse (husband or wife)
Parent (mother or father)
Finace(e)
Child (son or daughter)
Sibling (brother or sister)

19. Mother's Full name (first middle last):
*

20. Father's Full Name (first middle last)
*

21. Have you ever been arrested or convicted or a crime? If yes please provide the details including the date and place of the arrest and conviction and the sentence (punishment) you received.
*

Immigration & Travel Information

22. Date (month / day / year) you were last admitted to the United States.
*

23. Last U.S. Port of Entry (city state country):
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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:
*

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:
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29. Place of Passport Issuance (city province/state and country):
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30. Date of Passport Issuance (month / day / year):
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31. Passport Number:
*

32. Passport Expiration Date:
*

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

40. Do you intend to work or study in the United States? If yes please provide the name and address or the school or employer:
*

41. If your spouse or dependent children intend to work or attend school in the United States please provide the name and address of the employer or school for each person:
*

42. Name and address of your current employer or school:
*

43. Present occupation or course of study:
*

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 three (3) employers:
*

Do not enter anything in this field:

* indicates a required field