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your ability. If you do not understand a question or if you do not know the
answer, please indicate “DNK” (Do Not Know) and simply move on. This
Questionnaire is an internal information collection tool, and not something
that we will share with others, so we will understand if you cannot answer all
Immigration Questionnaire
Leave this row blank
Sponsoring Company Name Offered Job Title Location of Employment
DNK
PERSONAL
3. Please list any aliases you may have used (include maiden name, if applicable):
6. Please list your home addresses for the past five years, beginning with your most recent address:
Street Address City State or Province Country From To
Month/Year Month/Year
H.No:9-142, KHAMMAM(DT) A.P INDIA 1998 2008
NEAR:BUSSTAND,
ASWARAOPETA.
7. Please complete the following information.
8. IF YOU ARE PRESENTLY IN THE UNITED STATES, please provide the following information regarding your
initial entry and current immigration status. [Please note that “status” refers to the immigration classification
that you hold and is often reflected on the INS Form I-94 issued to you. “Visa” refers to the Nonimmigrant
Visa (if any) that is affixed to your passport and that was issued by a U.S. consulate.]
Date of Last Entry into Port of Entry of Form I-94 Number (11 digits) U.S. Immigration Status
U.S. (City/State) upon Entry
DNK DNK DNK DNK
Mode of Current U.S. Immigration Date Current Immigration U.S. Permanent Resident
Transportation Status Status Will Expire “A” Number
DNK DNK DNK DNK
Type of Visa You Date Current Visa Expires Place Current Visa Issued Number of Entries for
Possess which Visa is Valid
DNK DNK DNK DNK
9. Please list all languages that you speak, read, and/or write:
10. Please provide the following information regarding your current marital status:
Current Marital Status Date of Marriage Place of Marriage Number of Times Married
DNK DNK DNK DNK
11. Please provide the following information about your current spouse (if applicable):
Full Name (Maiden Name if Wife) Number of Times Date of Birth Age
Please list any aliases Married
DNK DNK DNK DNK
Place of Birth Nationality Current U.S. Date Current Type of Visa
City/Country Immigration Status Immigration Spouse Possesses
Status Will
Expire
DNK DNK DNK DNK DNK
Place Current Visa Issued Date Current Visa Date of Arrival in the U.S. Port of
Expires U.S. Entry
(City/State)
DNK DNK DNK DNK DNK
School(s) Attended Field(s) of Study Degree(s) Earned Date(s) Started Date(s) Ended
DNK DNK DNK DNK DNK
Current or Former Job Title(s) City/Country Where Date(s) Started Date(s) Ended
Employer Name(s) Employed
DNK DNK DNK DNK DNK
Has your spouse ever been arrested, convicted of a crime, or confined in prison -- anywhere? If yes, explain
DNK
12. If your spouse does not currently reside with you, please provide his/her current address:
13. Please provide the following information about your former spouse(s), if applicable:
Name of Former Spouse Date of Birth Date & Place of Marriage Date and Place of Divorce
DNK DNK DNK DNK
CHILDREN
14. Please list the following information about your children (if applicable):
Name Sex Place of Birth Date of Current Date Current Type of Visa
(City, Country) Birth Immigration Status Will He/She
Status Expire Possesses
DNK DNK DNK DNK DNK DNK DNK
Has any of your children ever been arrested, convicted of a crime, or confined in prison? If yes, explain
DNK
15. If any of your children does not currently reside with you, please provide his/her current address:
DEPENDENT SPONSORSHIP
16. If your spouse or child/children (unmarried and under 21) will need to be sponsored for a dependent visa
status based upon the filing of a petition or application principally on your behalf, or if they will need an
extension of their current dependent visa status, please provide the following:
PASSPORT INFORMATION
17. Please list the following passport information for you, your wife, and your children:
CHOICE OF CONSULATE
18. If you (or a family member) will need to apply for a nonimmigrant “visa” at a U.S. Consulate outside the
United States, please indicate at which consulate you will apply:
City Country
DNK DNK
PARENTS
20. Please list the following information about your spouse’s parents:
21. Please state if you have any U.S. Citizens or lawful permanent resident (LPR) in your family tree:
EDUCATION
22. Please list the following regarding your education:
School(s) Attended Field(s) of Study Degree(s) Date(s) Date(s)
(Name of School; City/Country) Earned Started Ended
MAHATMAGANDHI JR S.S.C SECOND
1996 1997
COLLEGE(ASWARAOPETA,INDIA)
J.M.V.JR.COLLEGE(YERRAGUNTA,INDIA) INTERMEDIATE SECOND 1997 2000
R.J.C.DEGREE DEGREE(B.S.C CS) FIRST
2000 2003
COLLEGE(KHAMMAM,INDIA)
TRINITY.PG.COLLEGE M.C.A FIRST WITH
DISTINCTIO 2003 2006
N
PROFESSION OR OCCUPATION
23. Please provide the following information regarding your current employer or, if you are not currently
employed, for your most recent employer, if applicable:
Your Job Title Date Started Date Ended Type of Business Hours Worked
Month/Year Month/Year Per Week
DNK DNK DNK DNK DNK
Describe the duties you performed:
DNK
24. Please provide the following information regarding your previous employers over the past 5 years, or for
any jobs you have held that relate to the occupation that you will pursue while in the United States:
25. Has an immigrant visa petition to classify you as an immigrant/permanent resident on the basis of your
profession or occupation ever been filed on your behalf? If so, please provide the following:
26. If you have ever applied for U.S. Permanent Resident (“green card”) status, please complete the following:
Did you file an I-485 Adjustment of Date You Filed Location Where Result of Filing
Status Application or did you apply Your You Filed Your
for an Immigrant Visa? Application Application
DNK DNK DNK DNK
27. If you (or a family member) have ever applied for a nonimmigrant visa to enter the United States please
provide the following:
Type of Visa Requested Location of U.S. Consulate Date of Visa Result of Visa Application
(specify nonimmigrant visa of Visa Application Application
category)
DNK DNK DNK DNK
28. List the inclusive dates of previous visits to the United States:
30. If you are INSIDE the United States, do you have any plans to travel abroad before your employer’s petition
on your behalf is filed with the government and/or while your employer’s petition is pending with the U.S.
government? If so, please provide:
MISCELLANEOUS
31. Have you ever: