Law Offices Of Elsa Martinez




Please fill out this questionnaire to the best of your ability. Correctly filling out this form is required before a telephone consultation can be scheduled . All information provided is kept in the strictest confidence. By submitting this form you are applying for a telephone consultation with one of our attorneys and agree to pay the telephone charges (client to call the attorney at a scheduled time) and the consultation fee of US$150.00 for a thirty (30) minute telephone consultation. Upon receiving your completed form you will be contacted to schedule your appointment consultation.
PRINCIPAL APPLICANT
Applicant's Full Name
First Name;
Middle Name:
Last Name:
Maiden Name:

General Information

Address:
City:
State/Province:
Country:
Home Phone:
Work Phone:
Fax:
Email:
Social Security No:
Day of Birth:			Ex:1956
Marital Status:
Gender:

Reason for requesting a telephone consultation:


Education
	School	Degree	Year
High School:
College:
Post Graduate:

Employment

	Job Title	Employer	Duration	Salary ($)
Current Job:
Responsibilities:

	Job Title	Employer	Duration	Salary ($)
Previous Job:
Responsibilities:

Certifications:

If you have been offered a job in the US, please provide:

	Job Title	Employer	Industry	Salary ($)
Current Job:
Responsibilities:

Immigration Information

Current Status:
Status Expires:
First Entry:
Last Entry:
# of Entires into US:
I-94 Number:

Please list your immigration status and dates for each previous period of stay in the U.S.:

			MM	DD	YYYY
Status 1:		Date 1:
Status 2:		Date 2:
Status 3:		Date 3:
Status 4:		Date 4:

Please list all visa petitions that you or your spouse ever had filed on your behalf:

Applicant

Visa Type:
	MM	DD	YYYY
Date Filed:
Result:
Sponsor:
Attorney:


Spouse

Visa Type:
	MM	DD	YYYY
Date Filed:
Result:
Sponsor:
Attorney:

Past Marriages Of Applicant

Name:
Citizenship:
Place of Marriage:
	MM	DD	YYYY
Date of Marriage:
	MM	DD	YYYY
Divorce/Death:

Please explain below any immigration problems you or your spouse may have ever had:


Family Information
If you don't have a spouse check this box

Spouse

First Name:
Middle Name:
Last Name:
Maiden Name:
Country Of Birth:
Citizen Of:
Gender:
	MM	DD	YYYY
Date of Birth:

Children

How many children do you have?

Parents
Applicant's Father

Name:
Citizen Of:
Country Of Birth:
	MM	DD	YYYY
Date of Birth:

Applicant's Mother

Name:
Citizen Of:
Country Of Birth:
	MM	DD	YYYY
Date of Birth:

Spouse's Father
Name:
Citizen Of:
Country Of Birth:
	MM	DD	YYYY
Date of Birth:

Past Marriages of Applicant

Spouse's Name:
Citizenship:
	MM	DD	YYYY
Date of Marriage:
Place of Marriage:
Number of Children:
	MM	DD	YYYY
Divorce/Death:

Of Current Spouse
His/Her Previous Spouse's Name:
Citizenship:
	MM	DD	YYYY
Date of Marriage:
Place of Marriage:
Number of Children:
	MM	DD	YYYY
Divorce/Death:

Miscellaneous Information

If you have ever been arrested or convicted, please explain in detail:


Please explain below if you have ever been denied a visa or refused admission to the United States:


Please list the years during which you have, if ever, filed an Income Tax Return with the IRS.


If you have ever received an Employment Authorization card, please list the numbers and validity dates.


If you have ever written work that was published or the subject of a publication (or other media) please summarize here the number of publications and names of the more significant publications.


If you have ever won a significant award, please list here:


Do you own or work for a business outside of the United States that may open a U.S. office?


Do you own or are you planning to invest in a U.S. business? If so, please describe the nature of the business.


If there is anything else you think we should know, please list here:


Sign Name:
	MM	DD	YYYY
Today's Date: