QUESTIONNAIRE FOR PERM BENEFICIARY

DATE THIS QUESTIONNAIRE IS BEING COMPLETED



LAST NAME

FIRST NAME

MIDDLE NAME

(Note: the way you write your name here will be the way it will eventually appear on your green card)


HOME ADDRESS (WHERE YOU LIVE) IN U.S.
Street
Apartment #
City
State
Zip Code


CONTACT INFORMATION IN U.S.
Home telephone number:
Work telephone number:
Mobile telephone number:
FAX Number:
Email address:


GENDER (CIRCLE ONE)MALEFEMALE


DATE OF BIRTH
CITY OF BIRTH
STATE/PROVINCE OF BIRTH
COUNTRY OF BIRTH


INTENDED JOB TITLE IN THE U.S.
INTENDED SALARY

DETAILS WITH RESPECT TO CURRENT ENTRY INTO THE U.S.

DATE OF MOST RECENT ARRIVAL IN U.S.
MOST RECENT I-94 NUMBER
CURRENT VISA STATUS
EXPIRATION DATE OF STAY
NAME OF AIRPORT WHERE YOU ENTERED THE U.S.

DETAILS WITH RESPECT TO EDUCATION

What is the highest level of education that you achieved that is relevant to the job for which you are being sponsored?
NoneHigh SchoolAssociate’s DegreeBachelor’s DegreeMaster’s DegreeDoctorateOther

What was your major field(s) of study?
What exact date (month, day, year) did you finish this relevant education?
What was the name of the school or university where this relevant education was completed?
What is the complete address of that school or university?
Full street address (PERM form requires this! – can be Registrar’s Office)
City, state/province
Country
Zip or postal code

DETAILS WITH RESPECT TO YOUR CURRENT JOB

NAME OF EMPLOYER
COMPLETE ADDRESS OF EMPLOYER
WHAT KIND OF BUSINESS DOES THE EMPLOYER ENGAGE IN?
WHAT IS YOUR CURRENT JOB TITLE? (Please note: if you have previously held other job title with this employer, list the details for each job separately in the additional spaces below, as if they were jobs with other employers)
FULL DATE (MONTH/DAY/YEAR) UPON WHICH YOU STARTED THIS PARTICULAR JOB
NUMBER OF HOURS WORKED PER WEEK
DETAILED DESCRIPTION OF THE JOB DUTIES THAT YOU ARE PERFORMING AT THE PRESENT TIME (include use of tools, machines, equipment, skills, qualifications, certifications, licenses, etc.):
COMPLETE TELEPHONE NUMBER OF EMPLOYER
WHAT IS YOUR SUPERVISOR’S NAME?

DETAILS WITH RESPECT TO YOUR PREVIOUS JOB

NAME OF EMPLOYER
COMPLETE ADDRESS OF EMPLOYER
WHAT KIND OF BUSINESS DID/DOES THE EMPLOYER ENGAGE IN?
YOUR JOB TITLE (if you previously held other job titles with this employer, please list the details for each job separately in the additional spaces below, as if they were jobs with other employers)
FULL DATE (MONTH/DAY/YEAR) UPON WHICH YOU STARTED THIS PARTICULAR JOB
FULL DATE (MONTH/DAY/YEAR) UPON WHICH YOU ENDED THIS PARTICULAR JOB
NUMBER OF HOURS WORKED PER WEEK
DETAILED DESCRIPTION OF JOB DUTIES PERFORMED (include use of tools, machines, equipment, skills, qualifications, certifications, licenses, etc.):
COMPLETE TELEPHONE NUMBER OF EMPLOYER
WHAT WAS YOUR SUPERVISOR’S NAME?