U.S. Residency Questionnaire
PERSONAL INFORMATION
Your full legal name:
*
Provide any other names you have ever used legally:
(maiden name, married name, etc.)
Your preferred phone number for immigration:
*
Your preferred email address for immigration:
*
Your date of birth:
*
-
Month
-
Day
Year
Date
Your city and country of birth:
*
All the countries you are a citizen of:
*
Do you currently have valid U.S. immigration status?
*
Yes
No
If so, what is your current immigration status in the U.S.?
When does your current U.S. immigration status expire?
Do you currently have a valid U.S. work permit?
*
Yes
No
If so, when does it expire?
If not, did you ever have a valid U.S. work permit in the past?
Yes
No
Your U.S. immigration Alien number (if you have one):
Your social security number (if you have one):
Your height (in feet and inches):
*
Your weight (in pounds):
*
Your eye color:
*
Your hair color:
*
Has any person or any employer ever apply for a U.S. visa petition for you, or your ex-spouse, or your parents before April 30, 2001 to be U.S. residents of the U.S.?
*
Yes
No
If so, in what year?
Who submitted the petition?
Who was the petition for?
ADDRESS INFORMATION
Provide a list of ALL your home addresses for the past 5 years including the months and years that you began to live and departed each address. Please begin with your current address first and continue backwards.
Current Address
Current Street Address
*
Apartment Number
City
*
State
*
Zip Code
*
Country
Start Date (Month & Year)
*
-
Month
-
Day
Year
End Date (Month & Year)
*
-
Month
-
Day
Year
Have you lived at this address for the last 5 years or longer?
*
Yes
No
Previous Address #1
Previous Street Address #1
Apartment Number
City
State
Zip Code
Country
Start Date (Month & Year)
-
Month
-
Day
Year
End Date (Month & Year)
-
Month
-
Day
Year
Do your current and previous address together cover the last 5 years?
Yes
No
Previous Address #2
Previous Street Address #2
Apartment Number
City
State
Zip Code
Country
Start Date (Month & Year)
-
Month
-
Day
Year
End Date (Month & Year)
-
Month
-
Day
Year
Do your current and 2 previous addresses cover the last 5 years?
Yes
No
Previous Address #3
Previous Street Address #3
Apartment Number
City
State
Zip Code
Country
Start Date (Month & Year)
-
Month
-
Day
Year
End Date (Month & Year)
-
Month
-
Day
Year
Do your current and 3 previous addresses cover the last 5 years?
Yes
No
Previous Address #4
Previous Street Address #4
Apartment Number
City
State
Zip Code
Country
Start Date (Month & Year)
-
Month
-
Day
Year
End Date (Month & Year)
-
Month
-
Day
Year
Do your current and 4 previous addresses cover the last 5 years?
Yes
No
Previous Address #5
Previous Street Address #5
Apartment Number
City
State
Zip Code
Country
Start Date (Month & Year)
-
Month
-
Day
Year
End Date (Month & Year)
-
Month
-
Day
Year
Do your current and 5 previous addresses cover the last 5 years?
Yes
No
Previous Address #6
Previous Street Address #6
Apartment Number
City
State
Zip Code
Country
Start Date (Month & Year)
-
Month
-
Day
Year
End Date (Month & Year)
-
Month
-
Day
Year
Do your current and 6 previous addresses cover the last 5 years?
Yes
No
Do you plan on changing home or mailing addresses within the next year?
*
Yes
No
Do you have a different mailing address that you prefer to receive mail from USCIS rather than your home address?
*
Yes
No
Preferred Mailing Address
Mailing Street Address
Apartment Number
City
State
Zip Code
Country
FOREIGN ADDRESS
If you previously lived outside of the U.S. for more than 1 year, then provide your last foreign address before coming to the U.S., with the dates.
Foreign Address
Mailing Street Address
Apartment Number
City
State / Department / Province
Zip / Postal Code
Country
Start Date (Month & Year)
-
Month
-
Day
Year
End Date (Month & Year)
-
Month
-
Day
Year
OCCUPATION & EDUCATION INFORMATION
List of ALL your jobs and schools for the last 5 years (list in order, begin with most recent first and continue backwards):
Are you currently working or going to school?
*
Yes
No
If you are currently unemployed or retired, what is the source of your current financial support?
Have you worked or attended school in the last 5 years?
Yes
No
What is the total number of jobs and schools you had in the past 5 years:
Current Employer or School
Name of Current Employer or School:
Job Title or School Type:
Street Address:
City:
State:
Zip Code:
Start Date (Month & Year):
-
Month
-
Day
Year
End Date (Month & Year):
-
Month
-
Day
Year
Have you worked or attended this job or school for the last 5 years or longer?
Yes
No
Previous Job or School #1
Name of Previous Employer or School:
Job Title or School Type:
Street Address:
City:
State:
Zip Code:
Start Date (Month & Year):
-
Month
-
Day
Year
End Date (Month & Year):
-
Month
-
Day
Year
Does this job or school along with any current job cover the last 5 years?
Yes
No
Previous Job or School #2
Name of Previous Employer or School:
Job Title or School Type:
Street Address:
City:
State:
Zip Code:
Start Date (Month & Year):
-
Month
-
Day
Year
End Date (Month & Year):
-
Month
-
Day
Year
Do these 2 previous jobs and schools and any current job now cover the last 5 years?
Yes
No
Previous Job or School #3
Name of Previous Employer or School:
Job Title or School Type:
Street Address:
City:
State:
Zip Code:
Start Date (Month & Year):
-
Month
-
Day
Year
End Date (Month & Year):
-
Month
-
Day
Year
Do these 3 previous jobs and schools and any current job now cover the last 5 years?
Yes
No
Previous Job or School #4
Name of Previous Employer or School:
Job Title or School Type:
Street Address:
City:
State:
Zip Code:
Start Date (Month & Year):
-
Month
-
Day
Year
End Date (Month & Year):
-
Month
-
Day
Year
Do these 4 previous jobs and schools and any current job now cover the last 5 years?
Yes
No
Previous Job or School #5
Name of Previous Employer or School:
Job Title or School Type:
Street Address:
City:
State:
Zip Code:
Start Date (Month & Year):
-
Month
-
Day
Year
End Date (Month & Year):
-
Month
-
Day
Year
Do these 5 previous jobs and schools and any current job now cover the last 5 years?
Yes
No
Previous Job or School #6
Name of Previous Employer or School:
Job Title or School Type:
Street Address:
City:
State:
Zip Code:
Start Date (Month & Year):
-
Month
-
Day
Year
End Date (Month & Year):
-
Month
-
Day
Year
Do these 6 previous jobs and schools any any current job now cover the last 5 years?
Yes
No
FOREIGN EMPLOYMENT OR SCHOOL INFORMATION
Did you attend school or work in a foreign country before coming to the U.S.?
*
Yes
No
Were you unemployed or retired in a foreign country before coming to the U.S.?
*
Yes
No
If you were unemployed or only attending school before coming to the U.S., what was the source of your financial support?
*
Foreign Employment or School
Name of Foreign Employer or School:
Job Title or School Type:
Foreign Street Address:
City:
State / Department / Province:
Zip / Postal Code:
Start Date (Month & Year):
-
Month
-
Day
Year
End Date (Month & Year):
-
Month
-
Day
Year
PARENT INFORMATION
Were any of your parents U.S. citizens before you turned 18?
*
Yes
No
If so, were your parents legally married before you turned 18?
Yes
No
Father's Information
Full Legal Name
*
First Name
Middle Name
Last Name
Any Other Name Used
First Name
Last Name
Place of Birth
*
City of Birth
State / Department of Birth
Country of Birth
Date of Birth
*
-
Month
-
Day
Year
Date
Is your father alive?
*
Yes
No
If not, when did your father pass away?
-
Month
-
Day
Year
Place of Current Residence
City of Current Residence
State / Department of Residence
Country of Current Residence
Mother’s Information
Full Legal Name
*
First Name
Middle Name
Last Name
Any Other Name Used
First Name
Last Name
Place of Birth
*
City of Birth
State / Department of Birth
Country of Birth
Date of Birth
*
-
Month
-
Day
Year
Date
Is your mother alive?
*
Yes
No
If not, when did your mother pass away?
-
Month
-
Day
Year
Place of Current Residence
City of Current Residence
State / Department of Residence
Country of Current Residence
Marital Information
What is your marital status?
*
Single
Married
Divorced
Widowed
In total, how many times have you ever been legally married?
Have you ever been divorced?
*
Yes
No
In total, how many times have you been divorced?
Marriage Information
Date of Marriage
-
Month
-
Day
Year
Place of Marriage
City of Marriage
State / Department of Marriage
Country of Marriage
Spouse’s Full Legal Name
First Name
Middle Name
Last Name
Spouse's Full Maiden Name
First Name
Middle Name
Last Name
Spouse's Place of Birth
City of Birth
State / Department of Birth
Country of Birth
Spouse’s Birth Date
-
Month
-
Day
Year
Spouse’s U.S. Alien Immigration Number (if any):
Is your spouse a current member of the U.S. military?
Yes
No
Divorce Information #1
Ex-Spouse's Full Name
First Name
Last Name
Ex-Spouse's Date of Birth
-
Month
-
Day
Year
Ex-Spouse's Citizenship
Ex-Spouse’s U.S. Alien Immigration Number (if any):
Date of Prior Marriage
-
Month
-
Day
Year
Place of Prior Marriage
City
State / Department / Province
Country
Date of Divorce
-
Month
-
Day
Year
Place of Divorce
City
State / Department / Province
Country
Did you have a prior divorce?
Yes
No
Divorce Information #2
Ex-Spouse's Full Name
First Name
Last Name
Ex-Spouse's Date of Birth
-
Month
-
Day
Year
Ex-Spouse's Citizenship
Ex-Spouse’s U.S. Alien Immigration Number (if any):
Date of Prior Marriage
-
Month
-
Day
Year
Place of Prior Marriage
City
State / Department / Province
Country
Date of Divorce
-
Month
-
Day
Year
Place of Divorce
City
State / Department / Province
Country
Did you have an additional prior divorce?
Yes
No
Divorce Information #3
Ex-Spouse's Full Name
First Name
Last Name
Ex-Spouse's Date of Birth
-
Month
-
Day
Year
Ex-Spouse's Citizenship
Ex-Spouse’s U.S. Alien Immigration Number (if any):
Date of Prior Marriage
-
Month
-
Day
Year
Place of Prior Marriage
City
State / Department / Province
Country
Date of Divorce
-
Month
-
Day
Year
Place of Divorce
City
State / Department / Province
Country
Did you have another prior divorce?
Yes
No
Spouse Death Information
Deceased Spouse's Full Name
First Name
Last Name
Deceased Spouse's Date of Birth
-
Month
-
Day
Year
Deceased Spouse's Citizenship
Deceased Spouse’s U.S. Alien Immigration Number (if any):
Date of Prior Marriage
-
Month
-
Day
Year
Place of Prior Marriage
City
State / Department / Province
Country
Date of Death
-
Month
-
Day
Year
Place of Death
City
State / Department / Province
Country
CHILDREN INFORMATION
Do you have any children anywhere in the world? (Including any missing, deceased, in other countries, current stepchildren, or legally adopted children)
*
Yes
No
How many children do you have in total in the entire world?
Are you planning to have any new children in the next 1-2 years?
*
Yes
No
Child Information #1
Child #1 Full Name
*
First Name
Middle Name
Last Name
Child’s U.S. Alien Immigration Number (if any):
Child's Date of Birth
*
-
Month
-
Day
Year
Does child #1 live with you?
*
Yes
No
Child #1 Current Address
Street Address
Apartment Number
City
State / Province
Postal / Zip Code
Is child #1 also applying for U.S. residency along with you?
*
Yes
No
Child #1 Social Security Number (if any)
Child #1 Height (in feet and inches)
Child #1 Weight (in pounds)
*
Child #1 Hair Color
Child #1 Eye Color
Is your current spouse the other biological parent of child #1?
Yes
No
Name of Other Biological Parent of Child #1
First Name
Last Name
Date of Birth of Other Biological Parent of Child #1
-
Month
-
Day
Year
Place of Birth of Other Biological Parent of Child #1
City of Birth
Country of Birth
Do you have a 2nd child?
Yes
No
Child Information #2
Child #2 Full Name
First Name
Middle Name
Last Name
Child’s U.S. Alien Immigration Number (if any):
Child Date of Birth
-
Month
-
Day
Year
Does child #2 live with you?
Yes
No
Child #2 Current Address
Street Address
Apartment Number
City
State / Province
Postal / Zip Code
Is child #2 also applying for U.S. residency along with you?
Yes
No
Child #2 Social Security Number (if any)
Child #2 Height (in feet and inches)
Child #2 Weight (in pounds)
Child #2 Hair Color
Child #2 Eye Color
Is your current spouse the other biological parent of child #2?
Yes
No
Name of Other Biological Parent of Child #2
First Name
Last Name
Date of Birth of Other Biological Parent of Child #2
-
Month
-
Day
Year
Place of Birth of Other Biological Parent of Child #2
City of Birth
Country of Birth
Do you have a 3rd child?
Yes
No
Child Information #3
Child #3 Full Name
First Name
Middle Name
Last Name
Child’s U.S. Alien Immigration Number (if any):
Child's Date of Birth
-
Month
-
Day
Year
Does child #3 live with you?
Yes
No
Child #3 Current Address
Street Address
Apartment Number
City
State / Province
Postal / Zip Code
Is child #3 also applying for U.S. residency along with you?
Yes
No
Child #3 Social Security Number (if any)
Child #3 Height (in feet and inches)
Child #3 Weight (in pounds)
Child #3 Hair Color
Child #3 Eye Color
Is your current spouse the other biological parent of child #3?
Yes
No
Name of Other Biological Parent of Child #3
First Name
Last Name
Date of Birth of Other Biological Parent of Child #3
-
Month
-
Day
Year
Place of Birth of Other Biological Parent of Child #3
City of Birth
Country of Birth
Do you have a 4th child?
Yes
No
Child Information #4
Child #4 Full Name
First Name
Middle Name
Last Name
Child’s U.S. Alien Immigration Number (if any):
Child's Date of Birth
-
Month
-
Day
Year
Does child #4 live with you?
Yes
No
Child #4 Current Address
Street Address
Apartment Number
City
State / Province
Postal / Zip Code
Is child #4 also applying for U.S. residency along with you?
Yes
No
Child #4 Social Security Number (if any)
Child #4 Height (in feet and inches)
Child #4 Weight (in pounds)
Child #4 Hair Color
Child #4 Eye Color
Is your current spouse the other biological parent of child #4?
Yes
No
Name of Other Biological Parent of Child #4
First Name
Last Name
Date of Birth of Other Biological Parent of Child #4
-
Month
-
Day
Year
Place of Birth of Other Biological Parent of Child #4
City of Birth
Country of Birth
Do you have a 5th child?
Yes
No
Child Information #5
Child #5 Full Name
First Name
Middle Name
Last Name
Child’s U.S. Alien Immigration Number (if any):
Child's Date of Birth
-
Month
-
Day
Year
Does child #5 live with you?
Yes
No
Child #5 Current Address
Street Address
Apartment Number
City
State / Province
Postal / Zip Code
Is child #5 also applying for U.S. residency along with you?
Yes
No
Child #5 Social Security Number (if any)
Child #5 Height (in feet and inches)
Child #5 Weight (in pounds)
Child #5 Hair Color
Child #5 Eye Color
Is your current spouse the other biological parent of child #5?
Yes
No
Name of Other Biological Parent of Child #5
First Name
Last Name
Date of Birth of Other Biological Parent of Child #5
-
Month
-
Day
Year
Place of Birth of Other Biological Parent of Child #5
City of Birth
Country of Birth
Do you have a 6th child?
Yes
No
INCOME INFORMATION
Have you worked in the U.S. for at least 10 years with a valid social security number?
*
Yes
No
Have you reported your taxes for this most recent year?
*
Yes
No
If so, how much did you report on your IRS federal taxes this most recent year?
Did you claim any dependents on your most recent federal taxes?
Yes
No
If so, how many?
Do you plan to report your taxes for the next 1-2 years?
*
Yes
No
Have you ever requested financial aid or public benefits while in the U.S.? (for example: Supplemental Security Income (SSI), Food stamps, Temporary Assistance for Needy Families (TANF), or State, Tribal, territorial, or local, cash benefit programs for income maintenance.)
*
Yes
No
If so, what kind?
When did you begin receiving those benefits?
-
Month
-
Day
Year
When did you stop receiving those benefits?
-
Month
-
Day
Year
Who were the benefits for?
From which agency did you receive the benefits?
How much were you receiving in total per month?
Have you ever received long-term medical care in the U.S. at government expense?
*
Yes
No
If so, what kind?
When did you begin receiving long-term medical care?
-
Month
-
Day
Year
When did you stop receiving long-term medical care?
-
Month
-
Day
Year
Where were you receiving long-term medical care?
What is your total household debt amount acquired or combined after marriage? (for example, loans, mortgage, credit card debt.)
*
What is your total household asset value amount acquired or combined after marriage? (for example, equity value of your home, or that of a second car.)
*
What is your highest level of education completed?
*
Do you have any special skills, certifications, licenses or trainings to use for a job? If so, what kind?
*
IMMIGRATION HISTORY INFORMATION
Has anyone ever previously petitioned to bring you to the U.S.?
*
Yes
No
If so, who? When?
Have you ever applied for a U.S. visa from abroad at a U.S. Embassy or U.S. Consulate?
*
Yes
No
If so, what kind of visa or status?
What was the decision for that application?
When was the decision?
Have you ever applied for an immigration benefit in the past?
*
Yes
No
If so, what kind?
What was the decision?
When was the decision?
Have you ever previously had any sort of U.S. immigration status that expired or taken away?
*
Yes
No
If so, what happened?
Have you ever entered the U.S. before?
*
Yes
No
If so, how many times?
What were the dates of each entry to the U.S.?
What were the U.S. cities that you entered from each time?
How did you enter each time?
What was your immigration status that you entered the U.S. with each time?
Did you last enter the U.S. with either a U.S. visa or with tourist status?
Yes
No
If so, what did you tell the immigration officer for your reason for entering the U.S.?
When you last entered the U.S., did you still have a job in your home country or a rental agreement or mortgage for a home?
Did anything happen to you while in the U.S. that caused you to want to stay in the U.S. after you entered? If so, what happened? When did that begin?
Before you last entered the U.S., were you already dating your current partner/spouse from the U.S.? When did you two first start dating?
Have you ever previously violated any U.S. visa rules while in the U.S., such as working without a valid work permit, attending schools, or overstaying your permitted time?
*
Yes
No
Have you ever stated that you are a U.S. citizen to anyone?
*
Yes
No
Have you ever voted for any election in the U.S.?
*
Yes
No
Have you ever helped anyone enter, or try to enter, the United States illegally, including your own children or spouse?
*
Yes
No
If so, how many times? For who? When?
Have you ever misrepresented or lied to receive any public benefits in the United States?
*
Yes
No
If so, how many times? Where? How?
Have you ever lied to any immigration officials or ever used false documents for immigration related reasons?
*
Yes
No
If so, how many times? Where? How?
Have you ever been fingerprinted at the U.S. border or told not to return to the U.S. for 5 years after trying to enter the U.S. illegally?
*
Yes
No
If so, how many times? Where? When? What happened?
Have you ever been ordered removed or actually been physically removed or deported from the U.S.?
*
Yes
No
If so, how many times? When? Where? Why?
Have you ever been placed in immigration court proceedings?
*
Yes
No
If so, when? where? why?
Have you ever previously been ordered deported by a U.S. immigration judge or a U.S. immigration border agent?
*
Yes
No
If so, how many times? When? Where? Why?
Have you ever failed to appear for a U.S. immigration court hearing?
*
Yes
No
If so, when? Where? What happened?
Are you currently in removal proceedings with a U.S. immigration court?
*
Yes
No
If so, where? When is the next hearing? Is it the preliminary or final hearing?
CRIMINAL ARRESTS INFORMATION
Have you ever been arrested anywhere in the world?
*
Yes
No
If so, how many times have you been arrested?
What dates were you arrested? Where were the arrests? Why were you arrested?
What were the outcomes of your arrests? Were you ever placed on probation for a crime? If so, how many years was your probation ordered for? Did you complete all the requirements that the judge ordered?
Have you ever been to jail? If so, how many times? For how many days? Why were you in jail?
In the last 5 years, have you spent more than 180 days (6 months) in jail?
Yes
No
Have you ever violated a domestic violence protection restriction order in the U.S.?
*
Yes
No
Have you ever been charged with illegal firearm possession or sales in the U.S
*
Yes
No
Have you ever been charged with illegal gambling in the U.S.?
*
Yes
No
Have you ever been charged with prostitution or running a prostitution business in the U.S.?
*
Yes
No
Have you ever been charged with fraud or tax evasion of more than $10,000.00?
*
Yes
No
Have you ever been charged with giving false testimony or committing perjury?
*
Yes
No
Do you have any criminal arrests still pending or are you still on probation now?
*
Yes
No
NATIONAL SECURITY INFORMATION
Have you ever been a member of a communist, military, police, terrorist or Nazi organization?
*
Yes
No
If so, for what groups? What was your title or duty? When were you a member? Where?Did you ever witness torture, physical abuse or murder?
Did you ever receive military or weapons training?
*
Yes
No
Were you ever in the military in your country?
*
Yes
No
If so, for which military branch? What was your title and ranking? Where did you serve your duty? What were your normal assigned duties? What were the dates of your military service?
MEDICAL EXAM INFORMATION
Are you current with all your vaccines?
*
Yes
No
Do you have any tattoos?
*
Yes
No
If so, could any tattoo possibly be viewed as gang/criminal related?
Are you ready to undergo a physical exam that includes, a urine same, blood sample, physical exam, and drug test, including testing for marijuana?
*
Yes
No
Submit
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