LAW OFFICE OF KLAUDIA HALL, ESQ.

Immigration Matters Exclusively

9927 Stephen Decatur Hwy, Suite G-1, Ocean City, MD 21842
Phone: 410-213-9881; Fax: 410-213-9882
E-mail: Khall@immigrationusa.us

Family name First Middle

Address Abroad: House No, Street, Apartment City

State/Country Zip/Postal Code

Phone#

E-mail

Place of Birth: City State/Country

Date of Birth (Month/Day/Year):

Gender: Male Female

Social Security Number (include all numbers you ever used, if any)

Alien Registration Number (if any)

Passport Number

Place of Issuance (City State/Province Country)

Issuance Date (month/day/year) Expiration Date (month/day/year)

National Identification Number (if any)

Your prior periods of stay in the US (including month/day/year of arrival and departure, as well
as visa type):

Questionnaire for PERM Beneficiary 1

 LAW OFFICE OF KLAUDIA HALL, ESQ.
Immigration Matters Exclusively
9927 Stephen Decatur Hwy, Suite G-1, Ocean City, MD 21842
Phone: 410-213-9881; Fax: 410-213-9882
E-mail: Khall@immigrationusa.us

If in the United States, complete the following:

a. Date of Arrival b. “I-94” Number:

(Month/day/year): ____/____/____ __________________________

c. Current Nonimmigrant d. Expiration

Status: ______________________ (Month/day/year): _____________

e. Address in U.S.: (House No, Street, Apartment, City, State, Zip Code)

________________________________________________________________________

Has a prior visa petition ever been filed? __________If YES, then answer the following:

Where When Approved?___________________

Marital Status Married Single (Never Married) Widowed Divorced Separated

List number of children and ages

Details regarding your education

High School:
Name of School:
Name of Degree:
Major Field of study (Academic/Vocational):
Date Enrolled:
Date of Graduation:

Questionnaire for PERM Beneficiary 2

 LAW OFFICE OF KLAUDIA HALL, ESQ.
Immigration Matters Exclusively
9927 Stephen Decatur Hwy, Suite G-1, Ocean City, MD 21842
Phone: 410-213-9881; Fax: 410-213-9882
E-mail: Khall@immigrationusa.us

Bachelors:
Name of University:
Name of Degree:
Major Field of study:
Date Enrolled:
Date of Graduation:

Masters:
Name of University:
Name of Degree:
Major Field of study:
Date Enrolled:
Date of Graduation:

Details of your employment history [If easier, attach resume]

Name of Employer:

Address (No, street, city, postal code, country):

Occupation:

Month/day/year employment began:

Month/day/year employment ended:

Brief description of duties:

Name and phone number of the supervisor:

Name of Employer:
Questionnaire for PERM Beneficiary 3
 LAW OFFICE OF KLAUDIA HALL, ESQ.
Immigration Matters Exclusively
9927 Stephen Decatur Hwy, Suite G-1, Ocean City, MD 21842
Phone: 410-213-9881; Fax: 410-213-9882
E-mail: Khall@immigrationusa.us

Address (No, street, city, postal code, country):

Occupation:

Month/day/year employment began:

Month/day/year employment ended:

Brief description of duties:

Name and phone number of the supervisor:

Name of Employer:

Address (No, street, city, postal code, country):

Occupation:

Month/day/year employment began:

Month/day/year employment ended:

Brief description of duties:

Name and phone number of the supervisor:

Name of Employer:

Address (No, street, city, postal code, country):

Occupation:

Month/day/year employment began:

Month/day/year employment ended:

Brief description of duties:

Questionnaire for PERM Beneficiary 4

 LAW OFFICE OF KLAUDIA HALL, ESQ.
Immigration Matters Exclusively
9927 Stephen Decatur Hwy, Suite G-1, Ocean City, MD 21842
Phone: 410-213-9881; Fax: 410-213-9882
E-mail: Khall@immigrationusa.us

Name and phone number of the supervisor:

Name of Employer:

Address (No, street, city, postal code, country):

Occupation:

Month/day/year employment began:

Month/day/year employment ended:

Brief description of duties:

Name and phone number of the supervisor:

Have you ever:

Committed a crime of moral turpitude or drug-related offense for which
you were not arrested? (Y/N)

Been arrested, cited, charged, indicted, fined or imprisoned for breaking

a law, excluding traffic violations? (Y/N)

Been the recipient of an act of clemency or similar action? (Y/N)

Exercised diplomatic immunity to avoid prosecution in U.S.? (Y/N)

Received public assistance in U.S. from any source, or likely to in the future? (Y/N)

Engaged in prostitution in past 10 years, or likely to in future? (Y/N)

Engaged in unlawful commercialized vice such as illegal gambling? (Y/N)

Encouraged any alien to enter U.S. illegally? (Y/N)

Trafficked in any controlled substance? (Y/N)

Been in any way involved in any terrorist activity? (Y/N)

Questionnaire for PERM Beneficiary 5

 LAW OFFICE OF KLAUDIA HALL, ESQ.
Immigration Matters Exclusively
9927 Stephen Decatur Hwy, Suite G-1, Ocean City, MD 21842
Phone: 410-213-9881; Fax: 410-213-9882
E-mail: Khall@immigrationusa.us

Engaged in espionage or intend to once in the U.S.? (Y/N)

Been a member of or affiliated with the Communist Party? (Y/N)

Engaged in genocide or persecuted any person because of race, religion,

national origin or political opinion? (Y/N)

Been deported or excluded from the U.S.? (Y/N)

Committed fraud in order to obtain entry into the U.S.? (Y/N)

Left the U.S. to avoid being drafted into the U.S. Army? (Y/N)

Been a J nonimmigrant visitor and not complied with the 2-year foreign
residence requirement or obtained a waiver? (Y/N)

Withheld custody of a U.S. citizen child from a person granted custody of

the child? (Y/N)

Been a polygamist or plan to practice polygamy in the U.S.? (Y/N)

Claimed to be a U.S. citizen? (Y/N)

If answered YES to any of the above, explain fully below:

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

Date __________________ Signature_______________________________

Questionnaire for PERM Beneficiary 6