US VISA APPLICATION FORM

Template Application for U.S. Visa to be completed by Qatar Airways Cabin Crew (This is a template application for Qatar Airways Purposes Only)

Please note that the Reference Number is mandatory. Please refer to the email with the instructions & follow the guidelines in STEP 1 to acquire the UID.

ALL fields in the below form are mandatory – if fields are left blank – application will be considered incomplete and will not be accepted.

Staff ID: * 20808

Surname MALEKAR
*As per Passport Given Name GLADYS
*As per Passport
16-Mar-2020
USIN Date: *DD-MMM-YYYY
Have you ever used other names (maiden, Religious, Professional): Choosean
*Choose one
item. Reference No: * 64615830
If yes, please provide the following: Yes
No
Other Surname Used: NO
*As per Passport Other Given name used: No*As per Passport

Gender Choosean
*Choose One
item. Marital Status: Choose one an item.
*Choose Nationality INDIAN an item.
*Choose
Female Single
Date of Birth Male 15-Jan-1980
*DD-MMM-YYYY City ofMarried
Birth MUMBAI Country of Birth INDIA
*Enter Country
Divorced *City name
Widow
Choose an
Do you hold any other Nationality? *Choose oneitem.
Common Law Marriage Country
*Enter of Passport
Country Passport Number
*Passport number
Yes Civil union - Domestic partnership
Qatar Residence Permit No:
No RP
28035608267
*Qatari Legally Separated

Have you ever been to U.S.? Choosean

*Choose one
item. Date of Arrival: 05-Mar-2020
*DD-MMM-YYYY Length of stay: *No of days
Yes
No
Have you ever been issued U.S. Visa? Choosean
*Choose one
item. Visa number 20141826830001
*Indicated in VISA in RED
Yes
Date the last visa was issued: 02-Jul-2014
*DD-MMM-YYYY Are you applying for the same type of visa? (C1/D) Choose
*Chooseone
an item.
No
Yes
Are you applying from the same country as the above visa and is this your principal country of residence? Choosean
*Choose oneitem.
No
Yes
Have you been ten printed? (Finger print) Choosean
*Choose one
item.
No
Yes
Do you or did you hold a U.S. driver’s license? No*Choose
Choosean
one
item. *U.S. driving license number * Issuing state in U.S.
Yes
Have your U.S. visa been lost or stolen? NO
*If Yes, Explain
No
Have your U.S. visa been cancelled or revoked? NO
*If Yes, Explain

Have you ever been refused a U.S. visa or entry to U.S or withdrawn your application for admission at point of entry?

NO
*If Yes, Explain

Applicants Contact No (Personal): 97455192289

Mobile No (Personal)

Have you used any other phone numbers in the last five years? Choosean
*Choose one
item.
Yes
*Phone number *Phone numberNo *Phone number

*Phone number *Phone number *Phone number

E-Mail (Personal): glads_lavi@yahoo.com

*Email address (Personal)

Have you used any other email addresses in the last five years? Choosean
*Choose one
item.
Yes
gladyslaveena@gmail.com
*e-mail address *e-mail address No *e-mail address
Do you have a Social Media presence? (please provide information of the social media platform that you have used in the last five years. In the space next to the platform’s
name, enter the username or handle you have used on that platform. Please do not provide your passwords. If you have used more than one platform or more than one
username or handle on a single platform, select the platform name again and enter the second user name. If you have not used any of the listed social media platforms in
the last five years, select “NO”) Choose one *Choose an item.
Yes
(You do not need to list accounts designed/registered for use by multiple users within a business or other organization)
No
Choose
*Chooseone
*Choose one
one Username Choose
*Chooseoneone Username Choose
*Choose one
one Username
FACEBOOK FACEBOOK FACEBOOK
Choose
*Chooseone
TWITTER one Username Choose
*Chooseone
TWITTER one Username Choose
TWITTER
*Choose one
one Username
FACEBOOK
INSTAGRAM FACEBOOK
INSTAGRAM FACEBOOK
INSTAGRAM
TWITTER
Choose
*Chooseone
YOUTUBE one Username Choose
*Chooseone
TWITTER
YOUTUBE one Username Choose
TWITTER
YOUTUBE
*Choose oneone Username
INSTAGRAM
FACEBOOK
LINKEDIN FACEBOOK
INSTAGRAM
LINKEDIN FACEBOOK
INSTAGRAM
LINKEDIN
YOUTUBE
TWITTER
FLICKR TWITTER
YOUTUBE
FLICKR TWITTER
YOUTUBE
FLICKR
Do you wish to provide information about your presence on any other websites or applications you have used within last five years to create or share content (photos, videos,
LINKEDIN
INSTAGRAM
GOOGLE+ INSTAGRAM
LINKEDIN
GOOGLE+ INSTAGRAM
LINKEDIN
GOOGLE+
status updates, etc.)? Please provide the platform such as Dropshots, Eyespot, Media Max, etc.
FLICKR
YOUTUBE
MYSPACE Choosean
*Choose one
item. YOUTUBE
FLICKR
MYSPACE YOUTUBE
FLICKR
MYSPACE
(Please provide the name ofYes
GOOGLE+
LINKEDIN
PINTEREST LINKEDIN
GOOGLE+ unique social media identifier (username or handle) LINKEDIN
PINTEREST
the platform and the associated GOOGLE+
PINTEREST
for each social media platform you would like to list. This
MYSPACE
FLICKR
REDDIT No
does not include private messaging FLICKR
MYSPACE
REDDIT
on person-to-person messaging services such as WhatsApp or accounts FLICKR
MYSPACE
REDDIT
designed/registered for use by multiple users within a business or
PINTEREST
GOOGLE+
TUMBLR
other organization) GOOGLE+
PINTEREST
TUMBLR GOOGLE+
PINTEREST
TUMBLR
REDDIT
MYSPACE
ASK.FM MYSPACE
REDDIT
ASK.FM MYSPACE
REDDIT
ASK.FM
TUMBLR
PINTEREST
DOUBAN
*Platform Username TUMBLR
DOUBAN *Platform
PINTEREST Username TUMBLR
DOUBAN *Platform
PINTEREST Username
ASK.FM
REDDIT
QZONE(QQ) REDDIT
ASK.FM
QZONE(QQ) REDDIT
ASK.FM
QZONE(QQ)
DOUBAN
TUMBLR
TWOO
*Platform Username TUMBLR
DOUBAN
TWOO *Platform Username TUMBLR
DOUBAN
TWOO *Platform Username
QZONE(QQ)
ASK.FM
SINA WEIBO ASK.FM
QZONE(QQ)
SINA WEIBO ASK.FM
QZONE(QQ)
SINA WEIBO
TWOO
DOUBAN
TENCENT WEIBO DOUBAN WEIBO
TWOO
TENCENT DOUBAN
TWOO
TENCENT WEIBO
SINA
VINE WEIBO
QZONE(QQ) QZONE(QQ)
SINA
VINE WEIBO QZONE(QQ)
SINA
VINE WEIBO
TENCENT
TWOO
YOUKU
Passport No: WEIBO TWOO
TENCENT
YOUKU WEIBO
Passport issued in Country: TWOO
TENCENT
YOUKU QATAR WEIBO
WEIBO (VK) Z2362997
Passport No *Enter Country
VINE
SINA
VKONTAKTE SINA WEIBO (VK)
VINE
VKONTAKTE SINA
VINE
VKONTAKTEWEIBO (VK)
YOUKU WEIBO
TENCENT TENCENT WEIBO
YOUKU TENCENT
YOUKU WEIBO
VKONTAKTE (VK)
VINE VINE
VKONTAKTE (VK) VINE
VKONTAKTE (VK)
Passport issued city DOHA
YOUKU *City name Country of Passport/ Authority that Issued Passport:
YOUKU YOUKU *Enter Country
VKONTAKTE (VK)
Passport Issue Date: 02-Jul-2012 VKONTAKTE (VK) VKONTAKTE
Passport Expiry Date: (VK)
*DD-MMM-YYYY
01-Jul-2022
*DD-MMM-YYYY
Passport Book Number: *South American Nationality only

Have you ever lost a passport or had one stolen? Choose one Passport No:
Yes
If yes, please provide the following: *If Yes, Explain
No*Choose an item. *Missing passport details Country
If Yes, Please Explain

Father’s Information Mother’s Information

Surname MALEKAR
*As per Passport Surname MALEKAR
*As per Passport

Given Name LUTHER

*As per BASKER
Passport Given Name *As per Passport

Date of Birth 23-Jan-1946

*DD-MMM-YYYY Date of Birth 07-Mar-1954
*DD-MMM-YYYY

Is he in US Choose one
*Choose an item. Choose one Is she in US Choose one
*Choose an item. Choose one
Yes US Citizen Yes US Citizen
No US Legal Permanent Resident No US Legal Permanent Resident
Non Immigrant Non Immigrant
Don'tChoose one
Do you have any immediate relatives, not including
Other parents, in U.S.? (Blood relation) *Choose Visa status: to*Choose
Relationship
/ Don't Know Choosean
one
item. Other /you Know
an item.
If yes, please provide the following: Yes SPOUSE
No FIANCE / FIANCEE
Surname *As per Passport Given name *As per Passport Visa status toChoose
Relationship you one*Choose an item.
US CITIZEN CHILD
Do you have any other relatives in U.S.? SIBLING RESIDENT
US LEGAL PERMANENT
Choosean
*Choose one
item.
NON IMMIGRANT
Yes
OTHER / DON'T KNOW
No
If the applicant is Married, Please provide your Spouse Information:

Surname KUMAR
*As per Passport Given name PRAVEEN
*As per Passport

Date of Birth 01-Nov-1977

*DD-MMM-YYYY Nationality INDIAN
*As per Passport

City of Birth RAICHUR

*As per Passport Country of Birth INDIA
*As per Passport

Address # *Address
1-4-89-32innear
U.S.mothers trust school ib road raichur

If the applicant is Divorced/Separated/Widow, former Spouse Information: Numberspouses

Number of former of former spouses
*Number

Surname *As per Passport Given name *As per Passport

Date of Birth *DD-MMM-YYYY Nationality *As per Passport

City of Birth *As per Passport Country of Birth *As per Passport

Date of Marriage *DD-MMM-YYYY Date of Marriage Ended *DD-MMM-YYYY

How the Marriage ended *Explain Country Marriage was Terminated *Country name

Were you previously employed (provide information for the last five years)? If yes, please provide the following: Choosean
*Choose one
item.
Yes
Employer name Employer address *Company address
*Company name No
City *City Country *Country

Job title *Position Supervisor’s Full name *Full name

Employed from *DD-MMM-YYYY Employed to (date) *DD-MMM-YYYY Telephone number *If known

Briefly describe duties

*Explain your role

Have you attended any educational institution, other than elementary school? Choosean
*Choose oneitem. If yes, please provide the following:
Yes
Name of Institute ALGAPPA UNIVERSITY HUBLI Institution address
*Institute name No *Institute address
City HUBLI
*City
Country Course of study MBA
KARNATAKA
*Country *Course

Studied from Studied to *DD-MMM-YYYY

*DD-MMM-YYYY

Please provide all the countries entered in last five years, both personally and as a cabin crew: You are required to mention at least 10 layover countries

*Country *Country *Country *Country *Country *Country

*Country *Country *Country *Country *Country *Country

*Country *Country *Country *Country *Country *Country

Please answer the following questions honestly.
Choose one
1. Do you belong to a clan or tribe? *Choose one
Yes
*If Yes, please provide the name
No of the clan
2. Have you belonged to, contributed to, or worked for any professional, social or charitable organizations? Choose one *Choose one
Yes
*If Yes, please provide the name of the organization
No
3. Do you have any specialized skills or training in firearms, explosives, nuclear, biological, or chemical experience? Choose one
*Choose one
Yes
4. Have you ever served in the military? If Yes, please provide following information Choose one No
*Choose one
Yes
Name of the Country *Country Rank / Position: *Rank Date of Service from
No *DD-MMM-YYYY
Branch of Service *Branch Military Specialty *Specialty Date of Service to *DD-MMM-YYYY
5. Have you ever served in, been a member of, or been involved with a paramilitary unit, vigilante unit, rebel group, guerilla group or insurgent group Choose one
*Choose one
6. Do you have a communicable disease of public health significance such as tuberculosis (TB)? Yes
Choose oneone
No*Choose
Yes
7. Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare of yourself or others? Choose one
No*Choose one
Yes
8. Are you or have you ever been a drug abuser or addict? Choose
No
*Chooseone
one
Yes
9. Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty, or other similar action? Choose one
No*Choose one
Yes
10. Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances? Choose one
No*Choose one
11. Are you coming to U.S. to engage in prostitution or unlawful commercialized vice or have you been engaged in prostitution or
Yes
procuring prostitutes within past 10 years?
Choose
No
*Chooseone
one
Yes
12. Have you ever been involved in or do you seek to engage in money laundering? No
Choose
*Chooseone
one
Yes
13. Do you seek to engage in espionage, sabotage, export control violations, or any other illegal activity while in the United States? Choose oneone
No*Choose
Yes
14. Do you seek to engage in terrorist activities while in the United States or have you ever engaged in terrorist activities? Choose
No one
*Choose one
Yes
15. Have you ever or do you intend to provide financial assistance or any other support to terrorists or terrorist organizations? Choose one
No*Choose one
Yes
16. Are you a member or representative of a terrorist organization? Choose
*Choose
No one
one
Yes
17. Have you ever committed, ordered, incited, assisted, or otherwise participated in torture? Choose
*Chooseone
one
No
Yes
18. Have you ever committed, ordered, incited, assisted, or participated in extrajudicial killings, political killings or other acts of violence? Choose
*Choose
No one
one
Yes
19. Have you, while serving as government official, been responsible for or involved in particularly any severe violations of religious freedom? Choose
*Chooseone
one
No
Yes
20. Have you ever sought to obtain or assist to obtain a visa, entry to U.S., by fraud or willful misrepresentation or other unlawful means? Choose
*Choose
No one
one
Yes
21. Have you ever withheld custody of U.S. citizen child out the U.S, from a person granted legal custody by a U.S. court? Choose
*Choose
No one
one
Yes
22. Have you voted in the United States in violation of any law or regulation? Choose
No
*Chooseone
one
Yes
23. Have you ever renounced United States citizenship for the purpose of avoiding taxation? Choose
No
*Chooseone
one
Yes
24. Have you ever been removed or deported from any country? Choose one No*Choose one
Yes
If Yes, please explain No
NO