Your Personal Information

*First Name:
*Last Name:
*Address 1:
Address 2:
*City:
*State/Province:
*Zip:	(5 or 9 digits)
*Country:
*Email Address:
*Home Telephone:
Work Telephone:
Fax Number:
Marital Status:	Single Married Widowed Divorced
Sex:	Male Female

Visa and Passport Information - If available.

Birthdate:	(e.g. mm/dd/yyyy)
Country of Birth:
Passport Issued By:	(country)
Expiration Date:	(e.g. mm/dd/yyyy)
Current Visa if Applicable:
Date Admitted:	(e.g. mm/dd/yyyy)
Expiration Date:	(e.g. mm/dd/yyyy)

Prior History

Have you ever applied for permanent resident status? Yes No

Describe your highest educational background:

If you are licensed in any profession, please state:

Describe any special qualifications, skills, proficiency
in use of tools, machines, equipment, or technology.

Relatives in the United States - Please list any relatives in the U.S. and state their relationship to you and their immigration status.

Job Offers - If you have a job offer, please explain.

When Should We Contact You? - Please indicate the most convenient times and days for a contact (indicate whether by phone or in person).