QUESTIONNAIRE FOR PERM BENEFICIARY [vc_row][vc_column] 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? [/vc_column][/vc_row]