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Consultation Form for Employment Based Issues

Step 1 of 6

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Phone

This field is for validation purposes and should be left unchanged.

I. Information Regarding Alien Applicant

Applicant Name(Required)

Prefix First Last Suffix

Other names (Maiden, Religious, Professional, Aliases)

Sex(Required)

Male

Female

Date of birth(Required)

Place of birth (City, State, Country)(Required)

City State / Province / Region Country

Citizenship (Country)(Required)

U.S. Social Security No.

Permanent address abroad(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

E-Mail(Required)

Enter Email Confirm Email

Telephone(Required)

Facsimile

U.S. Address

Street Address Address Line 2 City State ZIP Code

U.S. Telephone

U.S. Facsimile

If in the U.S., complete the following:

Date of arrival

I-94 No.

Current nonimmigrant status

Status expires

Place where last entered U.S.

Means of travel into U.S.

Did you talk with a Border or Pre-Flight Inspector on entry into U.S.?

Yes

No

Passport No.

Passport date issued

Passport date expires

Have you EVER falsely claimed to be a U.S. citizen (in writing or any other way)?(Required)

Yes

No

If yes, please provide details(Required)

II. Marital Information

Marital status(Required)

Married

Widowed

Divorced

Separated

Single

Will your spouse accompany you to the U.S.?

Yes

No

Spouse's name

Prefix First Last Suffix

Spouse - Other names

Spouse Sex

Male

Female

Spouse - Date of birth

Spouse - Place of birth (City, State, Country)

Spouse - Citizenship

Spouse - U.S. Social Security No.

Date of marriage

Place of marriage

III. Information Regarding U.S. Employer

Company name(Required)

Company address(Required)

Street Address Address Line 2 City State ZIP Code

Type of business

Date company established

IRS Tax No. (EIN)

No. of employees

Annual income - Gross ($)

Annual income - Net ($)

Position full-time?(Required)

Yes

No

Number of hours per week(Required)

Wages per week ($)(Required)

Other compensation (description)

Other compensation - Value ($)

Company contact name(Required)

Company telephone

Company facsimile

IV. Position Offered in the U.S.

Job title(Required)

Job duties(Required)

Location of employment

Street Address Address Line 2 City State ZIP Code

Work schedule - Start time

Hours

:

Minutes

AM/PM

Work schedule - End time

Hours

:

Minutes

AM/PM

Name of labor union

Minimum education/degree required to perform the job duties

Field of study

Do other persons with your job have this education/degree?

Yes

No

Special requirements/skills needed to perform the position

i.e., knowledge of certain types of computer software, foreign language, etc.

Minimum years of experience required

Title of immediate supervisor

Number of people you will supervise

V. Applicant’s Education

Education (add one row per degree)

School Name/Address

Field of Study

From (Mo/Yr)

To (Mo/Yr)

Degree

List professional licenses

VI. Applicant’s Prior Work Experience

Present & Prior Employment (add rows as needed)

Employer

Address

From (Mo/Yr)

To (Mo/Yr)

Job title

Job duties

Last occupation abroad - Employer

Last employer abroad - Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Last occupation abroad - From (Mo/Yr)

Last occupation abroad - To (Mo/Yr)

Last occupation abroad - Job title

Last occupation abroad - Job duties

Δ

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