RN Immigration Consultation Questionnaire

Registered nurses seeking permanent residence through an offer of employment in their profession may schedule a telephonic or in-person consultation with Senior Paralegal Elsa Garcia. Consultations for RNs cost $125. RNs who have legal questions should schedule a consultation with Mr. Shusterman. If you retain our law firm to represent you on the dayof your consultation, your consultation fee will be credited toward the fee for your case. In order to schedule a consultation with either Ms. Garcia or Mr. Shusterman, you must first complete the following Registered Nurse Immigration Consultation Questionnaire in full and send it to our office by clicking the button marked "Send Questionnaire" at the end of the form. If you wish, you may fax the questionnaire and any other documents which are relevant to your case to us at (213) 623-3720.

The information contained in the form should be about the RN who is seeking immigration benefits. It is important that you complete the form in its entirety. If you are an employer seeking to sponsor one or more RNs, a separate questionnaire should be completed for each nurse. If you are seeking to immigrate a relative who is a nurse, the information contained in the form should be about your relative.

Wait 10 to 20 minutes after you e-mail the questionnaire to our office, then call our receptionist at (213) 623-4592 to schedule a legal consultation. If you fail to schedule a consultation within 24 hours after sending the questionnaire, the form will be discarded. Please call us during our regular business hours (Monday through Friday, 9:00am to 5:00pm, Pacific Time).

If you retain our law firm to represent you on theday of your consultation, we will be happy to credit the entire consultation fee toward the cost of your case.

On the day of your consultation, please call the office at (213) 623-4592 ext.0 at the time scheduled. Consultations are 15 minutes in length and are scheduled at 20 minute intervals from 9:30am to 10:30am. If you call late, this will decrease the amount of time that you will be able to spend speaking with Ms. Garcia. If you must cancel or reschedule your consultation, please do so at least 24 hours in advance.

Ms. Garcia is not an attorney. Having a consultation with Ms. Garcia does not establish an attorney-client relationship.

All information contained in the following Immigration Consultation Questionnaire will bekept STRICTLY CONFIDENTIAL and will not be released without your permission.

INFORMATION ABOUT YOU
 Name

 Last:       First:     Middle: 

 Other names used (including maiden name):   Sex:  

 E-mail address:     

Current Address in U.S.
Number and Street:
City: State:    Zip: 
Last Address Outside of U.S.
Number and Street:
City:    State/Province:     Postal Code: 
Country:
Home Phone:
Hours we can call:
Fax Number:
Work Phone:
Hours we can call:
Pager/Cell Phone: 
Social Security No:
Citizen of:
Date and Place of Birth:
Date of Birth:
City or Town:
State or Province:
Country:
Passport Information:
Passport Country:
Passport Number:
Expiration Date:
 
 What type of immigration assistance are you seeking?
 

FAMILY INFORMATION
Husband or Wife           In the U.S.      Outside of U.S.       Unmarried
Spouse's Name
Last:       First:     Middle: 
Other names used (including maiden name):
Current Address (put "same" if you live together):
 
Date and Place of Birth:
Date and Place of Marriage:
Citizen of:
Applying with you?
Social Security Number:
Alien ("A") Number:
Immigration Status:
Expiration Date:
 Children
 Total Number of Sons and Daughters:
Name Sex Date & Country
of Birth
Citizen of Immigration
  Status
Expiration
Date
Applying
with You?
 Parents
Name Country of Birth Citizen of Immigration Status
Your
Father:
Your
Mother*:
Spouse's
Father:
Spouse's
Mother*:
* Use Mother's Maiden Name
 Previous Marriages              ( Check if Not Applicable)

Name

Date of
Marriage
Country of
Marriage

Kids?

Reason for
Termination
of Marriage
Date of
Termination
of Marriage
Country of
Termination
of Marriage
Your's:
Spouse's:

IMMIGRATION HISTORY
Current Immigration Status:
Date Status Expires:
Alien ("A") Number:
Date of First Entry into U.S.:
Last Entry into U.S.:
I-94 Number:
  Check every type of immigration status that you have ever held and provide the dates:
Immigration Status Date(s) Immigration Status Date(s)
B Visitor: E Trader/Investor:
F Student: H-1B Professional:
J Exchange Visitor: K Fiancee:
L Manager: O Outstanding Ability:
T/N Canadian Worker: Other:
  Check each one that you or your spouse have ever applied for or been the beneficiary of:
Y(you) or
S(Spouse)
Date Filed  Sponsor  Attorney  Result
Green Card
Immigrant petition
Labor certification
Asylum
Amnesty

 Have you or your spouse ever had any immigration problems? In particular, have you or
 your spouse ever been under removal, deportation, or exclusion proceedings? Please describe in detail:
 

EMPLOYMENT HISTORY
 Current Employer (or Employer Petitioning on Your Behalf)
Employer:
Address:
Job Title:     Salary:
Date of Hire: Are you related to your employer?

 May we contact your employer?
 If yes, whom may we contact:

Name Title Department Phone Number
 Employment in Last Five Years (anywhere in the world)
Job Title Employer Country Duration
 JOB QUALIFICATIONS

 List the professional licenses or certificates you possess, from any state or country:
 Select all that apply and attach a clean clear copy of each.

CGFNS State RN License      
Interim Permit Foreign RN License      
MELAB – English Language Certificate TOEFL (TSE/TWE)
NCLEX Letter from State Nursing Board VisaScreen

EDUCATIONAL BACKGROUND
 Please list all your education anywhere in the world:
Level School/Country Degree & Major Number of
   Years
Graduate?
College/University:
College/University:
Other Schooling:

OTHER INFORMATION
Have you or your spouse or children ever been arrested or convicted of a crime anywhere in the world (even if the conviction was expunged or removed from your record) or have you ever had any problems with the police?
If yes, please explain in detail:
Have you or your spouse or children ever claimed to be a citizen of the United States or have you ever used another name for immigration purposes or for any other reason?
If yes, please explain in Detail:
Have you or your spouse or children ever been denied a visa to come to the United States?
If yes, when and what kind of visa:
During what years, if any, have you and/or your spouse filed an Income Tax Return with the IRS?
If you or your spouse or children ever had an Employment Authorization Card issued by the INS, give number(s) and validity dates:
Is there anything, not already covered in this form, that you feel we should know?

STATEMENT OF TRUTHFULNESS

"By pressing the Send Questionnaire button below,
I certify that I have read and understood the instructions above this questionnaire.
I certify that all of the information contained in this form is true and correct to the best of my knowledge."



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