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Immigration Consultation Intake Form

Personal Information

Last Name First Name Middle Name
Other names used (including maiden name):
Gender
Email id:
Father Name Mother Name
Marital Status Spouse Information
 
Current Address in U.S. Number and Street:
City
State
Zip
 
Last Address Outside of U.S. Number and Street:
City
State
Zip
 
 

Contact Information
 
 
Home Phone
Work Phone
Hours we can call
Hours we can call
Fax Number
Pager/Cell Phone
Social Security No.:
Citizen of
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 Name
First Name
Middle Name
Other names used (including maiden name):
Current Address in U.S. Number and Street:
Date and Place of Birth:
Social Security Number:
Date and Place of Marriage:
Alien (“A”) Number
Citizen of
Immigration Status
Applying with you?
Expiration Date
 
 
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 Mothers Maiden Name

 
 

Previous Marriages: (Check if Not Applicable)

Name Date of Marriage Country of Marriage Kid? 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
 
 

Select every type of immigration status that you have ever held and provide the dates:

Immigration Status
Date
Immigration Status
Date
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
 
 

Write Y or S for each one that you or your spouse have ever applied for or been the beneficiary of:

(Y)for you and (S) Spouse
Date filed
Sponsor
Attorney
Result

Green Card

Immigration Petition

Labour Certification

Asylum

Amnesty

 
 

Employment History

Current Employer (or Employer Petitioning on Your Behalf)
 
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
 
How many years of experience do you have in your position or field?
 
 

Job Qualifications

List the professional licenses or certifications you possess, from any state or country:

 
 

Educational Background

Please list all your education anywhere in the world:

Level School/Country Degree & Major Number of Years Graduate?

College/University
College/University
College/University
College/University
 
 

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? If yes, please explain in detail:

 

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, please explain in detail:

 

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 signing below, I certify that I have read and understood the instructions above this questionnaire I certify that all of the information contained in this form is true and correct to the best of my knowledge”

AGREED AND ACCEPTED