Questionnaire

Background Questionnaire for Those Seeking Employment, a Work Visa or to Immigrate to the U.S.

Enter Secret code *:
 

Personal Data

First Name *:
Last Name *:
Date of Birth *:  
Place of Birth (country, city) *:
Citizenship *:
Address:
Phone (including country and area code):
E-mail *:
 

Family Information

Marital Status:
Name and Age of spouse (if applicable):
Number of children/ages:
 

Education

Name of Institute, Location of Institute, Specialty, Years attended/graduated:
Post-graduate education (if any):
Other training/courses/certifications:
 

Work Experience

Employment (please specify if you have ownership interest in business/employer), dates, position, description of duties:
 

Achievements

Awards/Publications/Patents/Memberships in Associations/Honors/Conference appearances:
 

Language (English)

don't know *:
Speak:
Read:
Write:
 

Language (French)

don't know *:
Speak:
Read:
Write:
 

Spouse (if applicable)

Spouse's Education:
Spouse's Professional Background:
 

Potential Employer

If applicable, potential Employer in US/Canada (Company Name, Address):
 

Relatives

Any family members in US/Canada? If yes, please specify (what? Names, ages?) and their status:
 

Past Travels

US * : — Yes
— No
Canada * : — Yes
— No
If yes, when? What kind of visa? How long were you there for?:
Have you ever been rejected for visa? (If yes, why?):
 

Assets

Assets for relocation *:
 

Other Issues

Any medical/criminal/security issues? If Yes, please detail::
Special Notes/Comments/Questions::
* - must be filled in

Contacts

White & Associates
22817 Ventura Blvd., Ste. 443
Los Angeles, CA 91364
(t) 1-818-730-3540
(f) 1-509-694-9786
us@bridgewest.com
Skype: bridgewesthome
Moscow, Russia
(t) 7 (905) 781-5442
(t) 7 (926) 202-8077
russia@bridgewest.com

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