PLEASE FAX ALL DOCUMENTS RELEVANT TO YOUR CASE TO US PRIOR TO YOUR CONSULTATION. OUR FAX NUMBER IS (213) 623-3720.

The information contained in the form should be about the person who is seeking a temporary visa, permanent residence, citizenship, relief from deportation or any other immigration benefit. It is important that you complete the form in its entirety. If you are an employer seeking to sponsor one or more employees, a separate questionnaire should be completed for each employee. If you are a citizen or permanent resident seeking to immigrate a relative, the information contained in the form should be about your relative.

Wait 10 to 20 minutes after you e-mail or fax the questionnaire to our office, then call our receptionist at (213) 623-4592, extension 0 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 (9:00am to 5:00pm, Pacific Time). The cost of the consultation is $425 (U.S.), payable by credit card (Visa, MasterCard or American Express) for 30 minutes. If you retain our law firm to represent you on the day of your consultation, we will be happy to credit the entire consultation fee toward the cost of your case.

Please note that if you retain our law firm to prepare a PERM application on your behalf, the law requires that the attorneys' fees in connection with the application plus costs (e.g., advertising, etc.) must be paid to our firm directly by your employer. Furthermore, if you retain us to prepare and submit an H-1B petition on your behalf, certain portions of the USCIS filing fees must be paid to our law firm directly by your employer.

On the day of your consultation, please call the office at (213) 623-4592, extension 0 at the time scheduled. Legal consultations are scheduled every 30 minutes from 10:00am to 3:30pm, excluding lunch time (noon to 1:30pm). No consultations for Mr. Shusterman are scheduled on Wednesdays. If you call late, this will decrease the amount of time that you will be able to spend speaking with the attorney. If it is necessary for you to cancel or reschedule your consultation, you must do so at least 24 hours in advance in order to obtain a refund.

Having a consultation with any of our attorneys does not establish an attorney-client relationship.

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

INFORMATION ABOUT YOU
Name Last:       First:     Middle:  Other names used (including maiden name):    Sex:   MF 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: MonthJanuaryFebruaryMarch AprilMayJuneJuly AugustSeptemberOctober NovemberDecember Day 010203 04050607 08091011 12131415 16171819 20212223 24252627 28293031 Year190019011902 1903190419051906 1907190819091910 1911191219131914 1915191619171918 1919192019211922 1923192419251926 1927192819291930 1931193219331934 1935193619371938 1939194019411942 1943194419451946 1947194819491950 1951195219531954 1955195619571958 1959196019611962 1963196419651966 1967196819691970 1971197219731974 1975197619771978 1979198019811982 1983198419851986 1987198819891990 1991199219931994 1995199619971998 1999200020012002 2003200420052006 2007200820092010 City or Town: State or Province: Country:	Passport Information: Passport Country: Passport Number: Expiration Date: MonthJanuaryFebruaryMarch AprilMayJuneJuly AugustSeptemberOctober NovemberDecember Day 010203 04050607 08091011 12131415 16171819 20212223 24252627 28293031 Year198019811982 1983198419851986 1987198819891990 1991199219931994 1995199619971998 1999200020012002 2003200420052006 2007200820092010 2011201220132014 2015201620172018
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? YesNo Social Security Number: Alien ("A") Number: Immigration Status: Expiration Date: MonthJanuaryFebruaryMarch AprilMayJuneJuly AugustSeptemberOctober NovemberDecember Day 010203 04050607 08091011 12131415 16171819 20212223 24252627 28293031 Year198019811982 1983198419851986 1987198819891990 1991199219931994 1995199619971998 1999200020012002 2003200420052006 2007200820092010 2011201220132014 2015201620172018
Children Total Number of Sons and Daughters: 01 234 567 89 Name Sex Date & Country of Birth Citizen of Immigration   Status Expiration Date Applying with You? MF U.S. CitizenPermanent Resident Resides AbroadOther YesNo MF U.S. CitizenPermanent Resident Resides AbroadOther YesNo MF U.S. CitizenPermanent Resident Resides AbroadOther YesNo MF U.S. CitizenPermanent Resident Resides AbroadOther YesNo MF U.S. CitizenPermanent Resident Resides AbroadOther YesNo
Parents Name Country of Birth Citizen of Immigration Status Your Father: U.S. CitizenPermanent Resident Resides AbroadDeceasedOther Your Mother*: U.S. CitizenPermanent Resident Resides AbroadDeceasedOther Spouse's Father: U.S. CitizenPermanent Resident Resides AbroadDeceasedOther Spouse's Mother*: U.S. CitizenPermanent Resident Resides AbroadDeceasedOther * 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: 12 345 678 90 DivorceDeath AnnulmentOther 12 345 678 90 DivorceDeath AnnulmentOther Spouse's: 12 345 678 90 DivorceDeath AnnulmentOther 12 345 678 90 DivorceDeath AnnulmentOther

IMMIGRATION HISTORY
Current Immigration Status: Date Status Expires: MonthJanuaryFebruaryMarch AprilMayJuneJuly AugustSeptemberOctober NovemberDecember Day 010203 04050607 08091011 12131415 16171819 20212223 24252627 28293031 Year198019811982 1983198419851986 1987198819891990 1991199219931994 1995199619971998 1999200020012002 2003200420052006 2007200820092010 2011201220132014 2015201620172018 Alien ("A") Number: Date of First Entry into U.S.: Last Entry into U.S.: MonthJanuaryFebruaryMarch AprilMayJuneJuly AugustSeptemberOctober NovemberDecember Day 010203 04050607 08091011 12131415 16171819 20212223 24252627 28293031 Year198019811982 1983198419851986 1987198819891990 1991199219931994 1995199619971998 1999200020012002 2003200420052006 2007200820092010 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 YS Green Card PendingApproved DeniedWithdrawn YS Immigrant petition PendingApproved DeniedWithdrawn YS Labor certification PendingApproved DeniedWithdrawn YS Asylum PendingApproved DeniedWithdrawn YS Amnesty PendingApproved DeniedWithdrawn
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? YesNo 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 certifications you possess, from any state or country: How many years of experience do you have in your position or field?

EDUCATIONAL BACKGROUND
Please list all your education anywhere in the world: Level School/Country Degree & Major Number of    Years Graduate? College/University: 12 345 6 YesNo College/University: 12 345 6 YesNo Other Schooling: 12 345 6 YesNo

OTHER INFORMATION
Have you 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? YesNo If yes, please explain in detail:
Have you 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? YesNo If yes, please explain in Detail:
Have you ever been denied a visa to come to the United States? YesNo If yes, when and what kind of visa:
During what years, if any, have you filed an Income Tax Return with the IRS?
If you 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." Type your name Type today's date