1.
Numele complet
2.
Adresa curenta :
Informatii despre statutul
dvs. actual in U.S.
Informatii despre ultima dvs. intrare in
U.S.
16. Dati numele dvs. exact cum
apare in cuponul I-94
17.
Localitatea
pe unde ati intrat in U.S.
Oras /Stat
18. Tipul de viza cu care ati intrat in
U.S. (daca ati intrat in mod ilegal, mentionati).
19. Ati fost
inspectat la vama cand ati intrat in U.S.?
YES
NO
23. Sexul
M
F
24. Starea civila
Necasatorit/a
Casatorit/a
Vaduv/a
Divortat/a
Separat/a
25. Ati mai aplicat
vreodata pentru rezidenta permanenta?
DA
NU
Daca da, dati urmatoarele detalii:
26 .
Informatii despre Sot/Sotie, daca se aplica
27 .
Informatii despre copiii dvs., daca se aplica
Daca aveti mai mult de 10 copii, folositi spatiul de mai
jos.
Este foarte important sa respectati ordinea informatiilor cerute.
28. Indicati
toate afilierile prezente sau trecute la vreun partid
sau organizatie politica. Daca nu se aplica, mentionati.
Informatii pentru procesare
Va rugam sa raspundeti la
urmatoarele intrebari cu da sau nu. Intrebarile sunt in
limba engleza. Daca nu intelegeti limba engleza, rugati
pe cineva sa traduca. Daca nu aveti pe nimeni care sa
traduca pentru dvs., sunati la numarul de telefon
(770) 271-5244.
Va rugam sa raspundeti cu sinceritate si transparenta la
toate intrebarile
1. Have you ever, in or outside
the U. S.:
a. knowingly committed any crime of moral turpitude or a
drug-related offense for which you have not
been arrested?
YES
NO
b. been arrested, cited, charged, indicted, fined or imprisoned
for breaking or violating any law or ordinance,
excluding traffic violations?
YES
NO
c.
been the beneficiary of a pardon, amnesty, rehabilitation decree, other
act of clemency or similar action?
YES
NO
d.
exercised diplomatic immunity to avoid prosecution for a criminal
offense in the U. S.?
YES
NO
2. Have you received public
assistance in the U.S. from any source, including the U.S. government or
any state, county, city or municipality
(other than emergency medical treatment), or are you likely to receive
public assistance in the future?
YES
NO
3. Have you ever:
a. within the past ten years been a
prostitute or procured anyone for prostitution, or intend to
engage in such activities in the future?
YES
NO
b. engaged in any unlawful commercialized
vice, including, but not limited to, illegal gambling?
YES
NO
c. knowingly encouraged, induced, assisted, abetted or aided any alien
to try to enter the U.S. illegally?
YES
NO
d. illicitly trafficked in any controlled
substance, or knowingly assisted, abetted or colluded in the
illicit trafficking of any controlled
substance?
YES
NO
4. 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 ever engaged or conspired to engage, in
sabotage, kidnapping, political assassination, hijacking or any other
form of terrorist activity?
YES
NO
5. Do you intend to engage in the U.S. in:
a. espionage?
YES
NO
b. any activity a purpose of which is
opposition to, or the control or overthrow of, the government of
the United States, by force, violence or other unlawful means?
YES
NO
c. any activity to violate or evade any
law prohibiting the export from the United States of goods,
technology or sensitive information?
YES
NO
6. Have you ever been a member of, or in any way affiliated
with, the Communist Party or any other totalitarian party?
YES
NO
7. Did you, during the period from 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?
YES
NO
8. 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?
YES
NO
9. Have you ever been deported from the U.S., or removed from
the U.S. at government expense, excluded within the past year, or are
you now in exclusion or deportation proceedings?
YES
NO
10.Are you under a final order of civil penalty for violating
section 274C of the Immigration and Nationality 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 U.S. or any immigration benefit?
YES
NO
11. Have you ever left the U.S. to avoid being drafted into
the U.S. Armed Forces?
YES
NO
12. Have you ever been a J nonimmigrant exchange visitor who
was subject to the two-year foreign residence requirement and not yet
complied with that requirement or obtained a waiver?
YES
NO
13. Are you now withholding custody of a U.S. citizen child
outside the U.S. from a person granted custody of the child?
YES
NO
14. Do you plan to practice polygamy in the U.S.?
YES
NO
Daca unul din raspunsurile dvs. este "Da"
la una sau mai multe din intrebari , folositi spatiul de mai jos
pentru a explica. Mentionati numarul intrebarilor. Raspunzand cu
"Da" nu inseamna neaparat ca nu va calificati pentru ajustare de
statut sau pentru rezidenta permanenta.
