Please fill out the questionnaire below and submit it to our office so that the attorney may be familiar with your case before consulting with you.  Should you have any problems completing the form below, please contact our office via email at info@usacitizenships.com or call us at (213) 784-1345 .
INFORMATION ABOUT YOU
First Name:
Last Name:
Middle Name:
Other Names Used (inluding
maiden name):
E-mail Address
Home Phone
Hours We Can Call:
Fax Number:
Work Phone:
Pager/Cellphone
Current Address in the U.S.
Number & Street:
City:
State:
Zip:
Last Address in the U.S.
Number & Street:
City:
State:
Postal Code:
Home Phone:
Hours we can Call:
Fax Number:
Work Phone:
Pager/Cellphone:
Birth Information
Date of Birth (mm/dd/yr):
City or Town:
State or Province:
Country:
Travel Documents

Passport Country:

Passport Number:
Expiration Date (mm/dd/yr):
Family Background
Husband or Wife:
 In the U.S.
Outside the U.S.
Unmarried

Spouse's Last Name:
Spouse's First Name:
Spouse's Middle Name:
Other Names used (including Maiden Name):
Current Address:
Date and Place of Birth :

Citizen of:

Applying with you?
Social Security Number:
Alien ("A")
Immigration Status:
Expiration Date (mm/dd/yr):
Children
Name:
Sex:
Date of birth (mm/dd/yr):
Citizen of:
Immigration Status:
Expiration Date (mm/dd/yr):
Joining your Application or Seperate:
   
Name:
Sex:
Date of birth (mm/dd/yr):
Citizen of:
Immigration Status:
Expiration Date (mm/dd/yr):
Joining your Application or Seperate:
   
Name:
Sex:
Date of birth (mm/dd/yr):
Citizen of:
Immigration Status:
Expiration Date (mm/dd/yr):
Joining your Application or Seperate:
   
Name:
Sex:
Date of birth (mm/dd/yr):
Citizen of:
Immigration Status:
Expiration Date (mm/dd/yr):
Joining your Application or Seperate:
   
Name:
Sex:
Date of birth (mm/dd/yr):
Citizen of:
Immigration Status:
Expiration Date (mm/dd/yr):
Joining your Application or
Seperate:
Parents (*Use Mothers Maiden Name)
Your Father's Name:
Country of Birht:
Citizen of:
Immigration Status:
 
*Your Mother's Name:
Country of Birth
Citizen of:
Immigration Status:
 
Spouse Father's Name
Country of Birth
Citizen of:
Immigration Status:
 
*Spouse's Mother's name:
Country of Birth
Citizen of:
Immigration Status:
Previous marriages
Check if not Applicable :
Your Name:
Date of Marriage
(mm/dd/yr):
Country of Marriage:
No. of Kids:
Date of Termination of
Marriage (mm/dd/yr):
Country of Termination of
Marriage:
Spouse's Name:
Date of Marriage:
Country of Marriage:
No. of Kids:
Date of Termination of
Marriage (mm/dd/yr):
Country of Termination of
Marriage:
Immigration History
Current Imigration Status:
Date Status
Expires(mm/dd/yr) :
Alien ("A")
Date of First Entry into U.S.
(mm/dd/yr):
Last Entry into U.S.
(mm/dd/yr):
I-94 Numbers
Check any immigration status that have ever been applicable
Immigration Satus:
B Visitor E Trader/ Investor
F Student H-1B Professional
J Exchange K Fiance
I manager O outstanding
T/N Canadian OTHERS
Dates of of Your Immigration Status(mm/dd/yr):
Others:
Check each one that you or our Spouse have ever applied for Beneficiary of:
Green Card:
Date Filed (mm/dd/yr):
Sponsor:
Attorney:
Result:
   
Immigration petition:
Date Filed (mm/dd/yr):
Sponsor:
Attorney:
Result:
   
Labor Certification :
Date Filed (mm/dd/yr):
Sponsor:
Attorney:
Result:
   
Asylum:
Date Filed (mm/dd/yr):
Sponsor:
Attorney:
Result:
   
Amnesty:
Date Filed (mm/dd/yr):
Sponsor:
Attorney:
Result:
   
Have you or your Spouse ever been
involved in deportation, removal
proceedings, or been dtained? Or had any
problems with immigration?
Employment History
Current Employer ( or Employer Petitiioning on Your Behalf )
Employer:
Address:
Job Title:
Date of Hire (mm/dd/yr):
Are you realated to your employer?:
May we contact your employer? if yes,
whom may we contact?:
Salary::
Employers
Name:
Title:
Department:
Phone Number:
Name:
Title:
Department:
Phone Number:
Please list your employment for the last five years
Job Title:
Employer:
Country:
Duration(mm/dd/yr)-(mm/dd/yr):
   
Job Title:
Employer:
Country:
Duration(mm/dd/yr)-(mm/dd/yr):
   
Job Title:
Employer:
Country:
Duration(mm/dd/yr)-(mm/dd/yr):
   
Job Title:
Employer:
Country:
Duration(mm/dd/yr)-(mm/dd/yr):
   
Job Title:
Employer:
Country:
Duration(mm/dd/yr)-(mm/dd/yr):
Professional Licensed you have obtained
List any advanced degrees or professional
Licenses:
How many years of experience do you have
in your poosition or field?:
Educational Background
Level:
School/Country:
Degrees & Major:
Number of Years:
Graduate?:
   
Level:
School/Country:
Degrees & Major:
Number of Years:
Graduate?:
   
Level:
School/Country:
Degrees & Major:
Number of Years:
Graduate?:
Past Actions
Have you ever been
arrested or convicted of a crime anywhere
in the world ( eif the conviction wa
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 to 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 oa visa to come
to the United States?:
If Yes, When and What kind of Visa?:
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
numbers(s):
Are there any other circumstances or
information not covered above that you
feel we should know about because it may
affect your case:
Authorization
By submitting this form,I am Authorizing USAcitizenships.com information in preparing my application to be sumbitted.
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