Click Here لتعبئة طلب الهجرة الامريكي اضغط هنا

Fill it out and Email it to: [email protected] .

(last modifyed August 20, 1998)

Please make sure to include a copy of your Resume/Bio-Data/Curriculum Vitae (CV).

                                      IMMIGRATION - QUESTIONNAIRE

1.      Country Most Interested in Migrating to [  ]Canada,[  ]Australia,[  ]New Zealand or [  ] USA.

                (If interested in more than one or all, Mark by 1st, 2nd, 3rd, or 4th Country of Preference).

2.             Name (full):                ___________________________

3.             Present Address:                 ____________________________________________________

    City:  ___________________, State/Province ____________, Zip/Pin ___________

4.             Phone No:          Home: ____________________ Work: ________________________

5.             Fax:                 _______________________________

6.                Nationality:                 ______________________________________________________

7.             Passport No.:                __________________ Expiration Date (MM/DD/YY): _____________

8.             Place of Birth: ________________________ Birth Date(MM/DD/YY): _______________

9.             Social Security / Identity Card No: _________________________________________ .

10.           Current Visa Status or Visa Holding(s), if any: _______________________________

11.           If Married, Date & Place of Marriage: ______________________________________

12.                Dependents:

                                NAME                 |PLACE OF BIRTH                |DATE OF BIRTH                |NATIONALITY

                                                |                 | (MM/DD/YY)                |

Spouse                  |                 |               |

Children                |                 |                       |

                        |                 |                       |

                        |                 |               |

13.           Total Number of  Years of Schooling Completed    _________________________________.

HIGH SCHOOL EDUCATION:

Name of Institution:

Location:

Date From:

Date To:

Part time/Full time:

Degree:

Special mentions:

POST SECONDARY EDUCATION:

Name of Institution:

Location:

Date From:

Date To:

Part time/Full time:

Degree:

Special mentions:

Name of Institution:

Location:

Date From:

Date To:

Part time/Full time:

Degree:

Special mentions:

Name of Institution:

Location:

Date From:

Date To:

Part time/Full time:

Degree:

Special mentions:

Name of Institution:

Location:

Date From:

Date To:

Part time/Full time:

Degree:

Special mentions:

14.                LANGUAGE ABILITY:                Mother tongue: _________________ Other: ________________

ENGLISH

Speak [ ] Not at all  [ ] With Difficulty [ ] Well   [ ] Fluently

Read   [ ] Not at all  [ ] With Difficulty [ ] Well  [ ] Fluently

Write  [ ] Not at all  [ ] With Difficulty [ ] Well  [ ] Fluently

FRENCH

Speak     [ ] Not at all  [ ] With Difficulty [ ] Well   [ ] Fluently

Read       [ ] Not at all  [ ] With Difficulty [ ] Well   [ ] Fluently

Write      [ ] Not at all  [ ] With Difficulty [ ] Well   [ ] Fluently

15. IF SELF EMPLOYED (otherwise skip to next question) :

                Name of Company:                ____________________________________________________

                How Long in Business:                ____________________________________________________

                Business Date Started:                ____________________              Dated Ended: _______________

                Type of Business:                ____________________________________________________

                Roles / Responsibilities in the Business: __________________________________

16.           Name and Address of Employers During the LAST 10 Years:

Name of company:

Location:

Date From:

Date To:

Part time/Full time:

Position:

Duties:

Name of company:

Location:

Date From:

Date To:

Part time/Full time:

Position:

Duties:

Name of company:

Location:

Date From:

Date To:

Part time/Full time:

Position:

Duties:

Name of company:

Location:

Date From:

Date To:

Part time/Full time:

Position:

Duties:

17.           ASSETS                 |Countries Where Located|Value in Local Currencies|(Converted to) US$s|

                Cash in Banks:    |                                               |                                                 |US$                      |

                Stocks and Bonds|                                            |                                                 |                                     |

                Real Estate:    |                                               |                                                 |                                    |                              

                Personal Assets   |                                               |

        (car, jewelry, etc.)

                Equity in Business:|                                              |                                         |                   |

                Other Assest:   |                       |                         |                   |

TOTAL ASSETS:                                                                                                                   |US$                            |

18.           DEBTS:          |Countries Where Located|Value in Local Currencies|(Converted to) US $|

                Loan from Banks                |                                               |                                                 |US$                      |

                Mortgages, Loans

         on Real Estate:|                                   |                                                 |                                     |

                Business Loan    |                                               |                                                 |                                    |                              

                Credit Card Debts|                                           |                                                 |                                     |

                Other DEBTS/LOANS|                                   |                                                 |                                     |

TOTAL DEBTS/LOAN AMOUNT:                                                                                              |US$                            |

19.           Any Family in Country of Migration (Destination) ?  [  ] Yes   or  [  ] No.

                Relationship:  _______________________                Location of  Relative ______________________.

20.           If Applying for Entrepreneur (Business) Category, Type of Business that you want

                to establish in the Migrating Country?:

                _________________________________________________________________________

                _________________________________________________________________________.

21.           Do you or Any Member of Your Family suffer from Any Medical Illness for which

                Medical Care is required:                [  ]Yes   or [  ] No.

                Details:                __________________________________________________________

                                                __________________________________________________________.

22.           Have You or Any Member of Your Family Been Convicted of Any Crime: [ ]Yes or [ ] No.

                Details:                 __________________________________________________________

                                                __________________________________________________________

Declaration:                  I/We Certify and Solemnly Declare that the above information provided by

Me/Us to Immigration and Visas International (IVI) for the purposes of processing My/Our

Immigration Application is TRUE to the Best of My/Our Knowledge and I/We Belief that

Nothing has been withheld.

Signature (Applicant):                _______________________________                Date:                ____________

If Spouse has work experience, please forward an Questionnaire sheet for him/her as well.

Please mention previous visa applications/refusals, Additional details on medical

conditions and criminal convictions below.

Comments:

Please Fax Or Email this Questionnaire At the Most Convenient Following Address:

Tele-Fax: 001-5084485565 - email : [email protected] - [email protected]
post address : Amman - Jordan - P.O.Box: 960811 - Zipcode: 11196

                                CORRESPONDENCE IS RESTRICTED AND  CLIENT CONFIDENTIAL