IMMIGRATION
LAW GROUP LLP
Phone: (408) 432-9200
Fax: (408)
432-9191
Please answer the
following questions:
Name: Male o Female o
First
Middle Last
Home Address:
Street
Address City State Zip Code
Other names
used:
Home
Phone Number: ( )
Date of Birth: City,
State/Province and Country of Birth: ________
Social Security
Number: - - I-94 Number:
Consulate where Visa
was issued:
Date of last
arrival: City
& State of last entry:
Were you inspected by
a U.S. Immigration Officer? o
Yes o No
Have you ever applied
for permanent residency before? o
Yes o No
If yes, please
explain:
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
If your answer is “Yes” on any one of these questions, explain on a separate piece of paper. Answering “Yes” does not necessarily mean that you are not entitled to register for permanent residence or adjust status.
Have
you ever, in or outside the
a. knowingly committed any crime of
moral turpitude or a drug-related offense for which you have not been arrested?
b. Been arrested, cited
charged, indicted, fined, or imprisoned for breaking or violating any law or
ordinance, excluding traffic violations?
c. Been the beneficiary of a
pardon, amnesty, rehabilitation decree, other act of
clemency or similar action?
d. Exercised diplomatic
immunity to avoid prosecution for a criminal offense in the
Have
you received public assistance in the
o Yes o No
Have you ever:
a. within the past 10 years been a
prostitute or procured anyone for prostitution, or intend to engage in such
activities in the future?
b. Engaged in any unlawful
commercialized vice, including, but not limited to, illegal gambling?
c. Knowingly encouraged,
induced, assisted, abetted or aided any alien to try to enter the
d. Illicitly trafficked in any controlled substance, or knowingly assisted, abetted or colluded in the illicit trafficking of any controlled substance? o Yes o No
Have you ever engaged in, conspired to engage in, or do you intend to engage in, or have you ever solicited membership or funds for, or have you through any means ever assisted or provided any type of material support to, any person or organization that has been engaged or conspired to engage, in sabotage, kidnapping, political assassination, hijacking, or any other form of terrorist activity? o Yes o No
Do
you intend to engage in the
a. espionage?
b. Any activity a purpose of
which is opposition to, or the control or overthrow of, the Government of the
c.
Any activity to violate or evade any law prohibiting the export from the
Have
you ever been a member of, or in any way affiliated with, the Communist Party
or any other totalitarian party?
o Yes o No
Did
you, during the period March 23, 1933 to May 8, 1945, in association with either
the Nazi Government of Germany or any organization or government associated or
allied with the Nazi Government of Germany, ever order, incite, assist or
otherwise participate in the persecution of any person because of race,
religion, national origin or political opinion?
o Yes o No
Have you ever engaged in genocide, or otherwise ordered, incited, assisted or otherwise participated in the killing of any person because of race, religion, nationality, ethnic origin, or political opinion? o Yes o No
Have
you ever been deported from the
Are
you under a final order of civil penalty for violating section 274C of the
Immigration Act for use of fraudulent documents, or have you, by fraud or
willful misrepresentation of a material fact, ever sought to procure, or
procured, a visa, other documentation, entry into the
Have
you ever left the
Have you ever been a J nonimmigrant exchange visitor who was subject to the 2 year foreign residence requirement and not yet complied with that requirement or obtained a waiver? o Yes o No
Are
you now withholding custody of a U.S. Citizen child
outside the
Do
you plan to practice polygamy in the