The Law Offices of

Brian T. O’Neill, P.C.

An Immigration and Naturalization Law Practice

50 Congress Street
Suite 236
Boston, MA 02109
Attorneys Telephone: 617-722-4000 ∙ Facsimile: 617-523-7837 Staff
Brian T. O’Neill, Sr. www.btolaw.com Douglas J. O’Neill
btoneill@btolaw.com doneill@btolaw.com
Brian T. O’Neill, Jr. Brenda Ibarra
boneill@btolaw.com bibarra@btolaw.com
Karen Benton
kbenton@btolaw.com

VISA QUESTIONNAIRE

In order to ascertain whether you qualify for a visa, we require certain information about
your professional and personal history. Please carefully consider all questions and provide
complete and detailed answers. If you need more space to answer a question, please attach
additional pages.

To expedite your obtaining a visa, please return this questionnaire to our office as quickly
as possible.

If you have any questions, please call Attorneys Brian T. O'Neill, Sr., Brian T. O'Neill, Jr.
or our staff, at (617) 722-4000.

1. Name of your prospective employer in U.S.:

2. Date of Questionnaire:

3. Your full name:

3a. Other names, including maiden name:

4. Present address:

5. Present telephone number: Home

Business

6. Date of Birth:

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7. Place of Birth:

8. Address of residence abroad to which you would return:

9. If you are outside of the United States, at what address in the U.S. will you reside?
(if known):

10. Your present employer and address:

11. Please provide the name of the person working for your present employer who is capable
of providing confirmation of your employment and other information.

Name:

Title:

Telephone Number:

12. Country or countries of your citizenship:

13. Has a consular officer ever denied your application for a visa? If yes, where

and when? What type of visa did you apply for?:

14. Have you ever applied for a J-1 Visa? If yes, where, when and

who was the petitioning organization? How long was the visa valid?

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15. Has an immigration officer ever refused or delayed your entry into the U.S.?

If yes, when?, where?, why?:

16. Have you ever expressed an intention to a U.S. consular officer to apply for an
immigrant visa or to immigrate permanently to the United States? If yes, where

and when?:

17. Has anyone ever filed an immigrant visa petition on your behalf? If yes, who
filed the petition?, where? and when?:

18. Has an application for alien employment certification in the U.S. ever been requested on
your behalf? If yes, when? where? by whom?:

19. Have you ever visited or lived in the United States? If yes, for each visit please
indicate arrival date in U.S., departure date, visa status, and purpose of visit:

(a) 1st visit:

(b) 2nd visit:

(c) 3rd visit:

20. Please list all your addresses and dates of residence for the past five years, including all
past addresses in the United States.
Address From/To

a.

b.

c.

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 PLEASE ATTACH ADDITIONAL PAGES TO CONTINUE YOUR RESPONSE, IF
NECESSARY.

21. Please list the names of all your relatives who reside in the United States, or who are
U.S. citizens or lawful permanent residents, or who are applying to become lawful
permanent residents.

Name of Relative Relationship Status in U.S.

a.

b.

c.

PLEASE ATTACH ADDITIONAL PAGES TO CONTINUE YOUR RESPONSE, IF

NECESSARY.

22. Have you ever been deported from the United States? Have you ever sought
to obtain a visa by misrepresentation or fraud? Have you ever been arrested
or convicted for any offense or crime? . If yes, please explain:

23. When do you plan to travel to/from the United States?

Departure from Arrival in U.S. at Date

a.

b.

c.

PLEASE ATTACH ADDITIONAL PAGES TO CONTINUE YOUR RESPONSE,

IF NECESSARY.

24. Do you possess an airline ticket for your return trip abroad? If yes, who will

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 pay for your airline tickets?

25. Please provide your social security number (if any):

26. Are you married? If yes, will your spouse accompany you to the U.S.?
. Will your spouse seek employment in the United States or attend school?
.

Please provide all information requested in questions 1 through 25 for your spouse
and provide a photocopy of your spouse's passport.

27. Do you have any children? If yes, will your children accompany you to the
United States? Will your children seek employment in the United States or
attend school? .

Please provide all information requested in questions 1 through 25 for your spouse
and provide a photocopy of your child's passport.

28. If you are not married, do you have any definite plans for marriage? If yes,

where and when do you plan to be married?

If you fiance/fiancee is not a U.S. citizen, please provide a copy of his/her passport
and resident alien card, if any.

29. Please describe, in reverse chronological order, all of your employment history including
promotions or transfers within the same employer.

a. Name and address of employer:

Job Title Date Started Date Left Hours per Week

Describe in detail the duties performed:

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PLEASE ATTACH ADDITIONAL PAGES TO CONTINUE YOUR DESCRIPTION OF ALL
EMPLOYMENT EXPERIENCE.

30. Please list all academic or vocational training institutions which you have attended, dates
of attendance, and degrees or certificates awarded or examinations passed.

Name of Institution Address From/To Degree

a.

b.

PLEASE ATTACH ADDITIONAL PAGES TO CONTINUE YOUR RESPONSE, IF

NECESSARY.

31. Please list any academic or professional honors that you have received.

32. Please list all professional organizations of which you are a member.

33. Please list all professional licenses of which you hold.

34. In your opinion, which of your skills will be most important to your new job in the
United States?

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 PLEASE ATTACH ADDITIONAL PAGES TO CONTINUE YOUR RESPONSE, IF
NECESSARY.

35. Please describe your managerial duties including number of persons that you manage for
your present job, and the date on which your managerial responsibilities began.

PLEASE ATTACH ADDITIONAL PAGES TO CONTINUE YOUR RESPONSE, IF

NECESSARY.

36. Please summarize your specialized knowledge or knowledge of proprietary information

or technology that will be useful to your employer in the U.S.

PLEASE ATTACH ADDITIONAL PAGES TO CONTINUE YOUR RESPONSE, IF

NECESSARY.

37. If applying for a green card, renewing a green card, or applying for citizenship, please
provide the following:

Alien Registration #:

U.S. Social Security #:

U.S. Tax Identification #, if any:

Last Name by Birth / Maiden Name:

Last Name by Marriage:

First Name:

Middle Name:

Date of Birth:

City, Town, Village of Birth:

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Country of Birth:

Race:

Ethnicity:

Height in Feet and Inches:

Weight in Pounds:

Eye Color:

Hair Color:

US Addresses for the past 5 years with dates:

1.

2.

3.

4.

5.

List of Employment for the past 5 years with dates:

1.

2.

3.

4.

5.

Foreign Address where you last lived:

Mother’s Last Name by Birth / Maiden Name:

Mother’s Last Name by Marriage:
Mother First Name:
Mother’s Middle Name:
Mother’s Date of Birth:

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Mother’s Place of Birth:
Mother’s Address:

Father’s Last Name by Birth:

Father’s First Name:
Father’s Middle Name:
Father’s Date of Birth:
Father’s Place of Birth:
Father’s Address:

Child #1’s Last Name by Birth:

Child #1’s First Name:
Child #1’s Middle Name:
Child #1’s Date of Birth:
Child #1’s Place of Birth:
Child #1’s Address:

Child #2’s Last Name by Birth:

Child #2’s First Name:
Child #2’s Middle Name:
Child #2’s Date of Birth:
Child #2’s Place of Birth:
Child #2’s Address:

Child #3’s Last Name by Birth:

Child #3’s First Name:
Child #3’s Middle Name:
Child #3’s Date of Birth:
Child #3’s Place of Birth:
Child #3’s Address:

Child #4’s Last Name by Birth:

Child #4’s First Name:
Child #4’s Middle Name:
Child #4’s Date of Birth:
Child #4’s Place of Birth:
Child #4’s Address:

Child #5’s Last Name by Birth:

Child #5’s First Name:
Child #5’s Middle Name:
Child #5’s Date of Birth:
Child #5’s Place of Birth:
Child #5’s Address:

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PLEASE ATTACH ADDITIONAL PAGES TO CONTINUE YOUR RESPONSE, IF
NECESSARY.

Date Signature

Please return this questionnaire to:

Law Offices of Brian T. O'Neill, P.C.

50 Congress Street
Suite 236
Boston, MA 02109
Tel. (617) 722-4000
Fax (617) 523-7837
E-mail: doneill@btolaw.com

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