FORMS PRE VISA APPLICATION QUESTIONNAIRE FORM Full Name Date of Birth Passport Number Passport Issue Date Passport Expiration Date Country of Issue 1. Are you married, single, divorced, separated, widowed, or engaged 2. National Insurance Number or U.S. Social Security Number 3. Please provide a date that you intend to travel and how long you will be staying. 4. Please provide U.S. address, City, State, Zip code & phone number you will visit 5. Is there anyone traveling with you? (Y/N) If yes please provide the full name of person and their relationship to you. 6. Please provide the last 5 travel dates to the United States as well as how many days, weeks or months you stayed there. 7. Have you ever had a U.S. driver's license? (Y/N) If yes which state and what was your driver's license number. 8. Have you ever been refused a U.S. visa or entry into the United States? (Y/N) If yes please provide date, and details. 9. Has your U.S. Visa ever been cancelled or revoked? (Y/N) If yes please provide year and details. 10. Do you have any family members in the United States that has ever filed a petition on your behalf for a green card for you to live there? (Y/N) If yes please provide the year and relationship of that family member. 11. Please provide your home address, P.O. Box number (if any), home phone number, cell phone number and work number . 12. Please provide your cell phone number and all phone numbers that you used before. 13. Please provide your email address and all email addresses that you used in the past (5) years. 14. Please provide all Social Media accoubts that use and iser names for each one. 15. Have you ever had a lost or stolen passport? (Y/N) If yes please provide the passport number, country issued and explain details. 16. Father full name, and date of birth 17. Please provide your mother's full name and her date of birth. Please provide your mother's maiden name before she got married. 18. Please provide the full names of your sister, brother, mother, father, or child if they live in the United States. Also provide their status if they have a green card or U.S. passport. 19. Do you have any other family members in the United States? (Cousins, Uncles, Aunts, Nieces, Nephews, Grandparents) 20. If married please provide, spouse full name, date of birth, place of birth (city, providence, country. If spouse is not living with you please provide address. 21. If divorced please provide former spouse name, date of birth, place of birth, date of marriage, date of divorce, reason for divorce and country where divorce was terminated. 22. If widowed please provide deceased spouse full name, date of birth, and place of birth. 23. If engaged please provide fiancé/fiancée full name. 24. PRESENT EMPLOYER: Please provide the company name or employer name, address, P.O.Box and phone number, the date you began, position and weekly salary 25. PAST (2) EMPLOYERS: Please provide full information of past (2) employers if you have not been on your present job over 5 years. Please provide name of companies, addresses, P.O.Box and phone numbers, date you began, date you left, previous position held and the first and last name of your supervisors. 26. PREVIOUS SCHOOLS ATTENDED: Please provide the names and addresses of any schools attended, the year started and the year completed, courses studied and degree earned. Please include primary school, elementary school, junior high school, high school as well as colleges and or universities. 27. Please provide all languages you speak 28. Please provide all countries you traveled in the past (5) years 29. SECURITY & MEDICAL: Have you ever been arrested or convicted for any crime in any country? (Y/N) If yes please provide: the year, city, state, or country. Please provide the offense or charge and the disposition or outcome of the case. 30. Have you ever overstayed your permitted time in the United States? Y/N If yes please state time entered and time you departed. Please provide the reason for overstay. 31. Have you ever been deported or ordered removed from the United States? (Y/N) If yes please provide date you were deported & the criminal violation felony offense in which you were deported or ordered removed. 32. Do you have any physical or mental health issues that will cause harm or danger to others? Y/N 33. Have you ever been an abuser or addict to any drugs or alcohol? Y/N Message Send