Immigration questionnaire for beneficiary

IMMIGRATION QUESTIONNAIRE FOR BENEFICIARY

 

INSTRUCTIONS: Please answer all questions completely. If a question is not applicable

                               Leave it blank. If answer is "none" enter "none".

Personal Information:

First Name:      

 

Middle Name:

 

Last Name:

 

All other names used (i.e. maiden name):

 

Current Address:

 

Number and Street:

City:

State:

Zip code:

 

Dates you lived at this address:

 

From: (mm/yyyy):                                                                                                        

To: (mm/yyyy):

             

Home Telephone:

 

Work Telephone:       

 

Cellular Telephone or Pager:     

 

Email Address:

 

Alien Number (if any):

 

United StatesSocial Security Number (if any): (xxx-xx-xxxx):                                 

 

Date of birth (mm/dd/yyyy): 

 

Place of birth (city/state/country):  

 

Physical Characteristics:

 

Height: (feet and inches):    Weight (pounds):

                       

Color of Hair:                Color of Eyes:

 

Complexion:                         Marks of Identification (i.e. birthmark):

Immigration Status:

 

Have you ever been issued a J-1 visa before? Yes    No

 

Has anyone filed a petition or application for you before? Yes    No

 

If Yes:

 

What is the name of the person who filed the petition or application for you?

First Name:

Middle Name:

Last Name:    

                                                                                                                         

What relation is this person to you (i.e husband, wife, parent, child):

 

Date petition or application was filed (mm/dd/yyyy):

 

Name (i.e. Petition for Alien Relative) and number of the petition or application (i.e. form I-30):

 

Are copies of the petition or application available? Yes       No

 

Passport Number:

 

Country of issuance of Passport:                     

 

Date of issuance of Passport:               

 

Expiration date of Passport:    

 

Was a Visa issued for your most current entry into the United States? Yes       No

 

If Yes:

 

Consulate where the Visa was issued: City: ; Country:

 

Date Visa was issued:(mm/dd/yyyy):

                       

Visa Number:               

 

Visa Type (i.e B-2):      

 

Date of last entry into the United States (mm/dd/yyyy):

 

Place of last entry into the United States: City: ; State:

 

Arrival Departure Record form I-94 Number (located in upper left hand corner):

    

Expiration date of Arrival Departure Record form I-94 (mm/dd/yyyy):

 

What is your current immigration status:

 

Have you ever before applied for permanent residence (“green card”)? Yes   No

 

If you applied for permanent residence, were you granted such status? Yes   No

 

If Yes:

How was your residence obtained?:

 

If No:

Why was your residence denied?:

 

Have you ever before applied for United States citizenship? Yes   No   

 

If Yes, please explain:

 

Have you ever before applied for employment authorization from the Immigration and

 

Naturalization Service? Yes        No

 

If Yes:

 

At which office: City: ; State:

 

Date of application (mm/dd/yyyy):

 

Was the application granted or denied?    Granted        Denied

 

Have you ever been under immigration proceedings? (i.e. refused admission to the United States by the INS, taken into custody by the INS, scheduled for an immigration court hearing)       

Yes      No  

 

If Yes, please explain:

 

If you were scheduled for an immigration hearing, please answer the following:

 

Did you attend the hearing?: Yes        No

 

Place of hearing: City: ; State:

 

Allegation or charge:

 

Disposition of your case (i.e. voluntary departure, removal, deportation):

 

MARITAL STATUS:

    

Current marital status:       Married

                                            Single, never married

                                            Divorced

                                            Widowed

 

If presently married, please provide the following:

 

Date of marriage (mm/dd/yyyy):

 

Place of marriage: City: ; State: ; Country:

 

Name of present spouse:

 

First Name:

Middle Name:

Last Name:

All other names used (i.e. maiden name):

 

Date of birth of present spouse (mm/dd/yyyy):

 

Place of birth of present spouse: City: ; State: ; Country:

 

Occupation or intended occupation of present spouse:

 

Are you currently living with your spouse? Yes   No

                   

If No, please explain the reason for not living with your present spouse (i.e. separated, intending divorce, occupational separation, living in separate countries):

 

Present spouse’s current address, if different that your current address:

 

Number and Street:

City:

State:

Zip code:

 

Dates spouse lived at this address: From: (mm/yyyy):

To: (mm/yyyy):

 

Most recent address at which you both lived together:

 

Number and street:

City:

State:

Zip code:

 

Dates you lived together at this address:    From: (mm/yyyy):

To: (mm/yyyy):

 

           

INFORMATION ON BENEFICIARY’S PREVIOUS SPOUSE(S):

If divorced:

 

Name of prior spouse:

 

Date of birth of prior spouse: (mm/dd/yyyy):

 

Place of birth of prior spouse: City: ; State: ; Country:

 

Date of Prior Marriage: (mm/dd/yyyy):

     

Place of Prior Marriage: City: ; State: ; Country:

 

Date of dissolution of marriage (mm/dd/yyyy):

 

Place of dissolution of marriage: City: ; State:

 

If divorced more than once:

 

Name of prior spouse:

 

Date of birth of prior spouse: (mm/dd/yyyy):

 

Place of birth of prior spouse: City: ; State: ; Country:

 

Date of Prior Marriage: (mm/dd/yyyy):

     

Place of Prior Marriage: City: ; State: ; Country:

 

Date of dissolution of marriage (mm/dd/yyyy):

 

Place of dissolution of marriage: City: ; State:

 

If prior spouse is deceased:

 

Date of death: (mm/dd/yyyy):

 

Place of death: City: ; State: ; Country:

 

INFORMATION ABOUT YOUR PARENTS:

Father:

                                   

First Name:

Last Name:

All other names used by your father:

 

Date of birth: (mm/dd/yyyy):                                               

 

Place of birth: City: ; State: ; Country:

 

Current address:

 

Number and Street:

City:

State:

Zip code:

Country:

 

If your father is deceased:

 

Date of death: (mm/dd/yyyy):

 

Place of death: City: ; State: ; Country:

                       

Mother:

                                   

First Name:

Last name:

All other names used by your mother (including maiden name):

 

Date of birth: (mm/dd/yyyy):                                               

 

Place of birth: City: ; State: ; Country:

 

Current address:

 

Number and Street:

City:

State:

Zip code:

Country:

 

If your mother is deceased:

 

Date of death: (mm/dd/yyyy):

 

Place of death: City: ; State: ; Country: