ALIKHAN LAW OFFICE, LLC

ONLINE FORM

If you would like professional advice from the Alikhan Law Office for immigration to either Canada or the United States, we request that you complete the following Immigration Consultation Questionnaire in full and send it to our office by clicking the button marked "Send Questionnaire" at the end of the form.

Having a consultation 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:
E-mail address:

Current Address in Canada or U.S.
Number and Street:
City: State: Zip:

Last Address Outside of Canada or 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 Married Divorced/Separated 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:

Applying with you?
Total Number of Sons and Daughters:

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:

ABILITY IN ENGLISH AND FRENCH
[applicable for Canadian applicants only]

Your Ability
ENGLISH		FRENCH
Read:		Read:
Write:		Write:
Speak:		Speak:
Listen:		Listen:

Your Spouse
ENGLISH		FRENCH
Read:		Read:
Write:		Write:
Speak:		Speak:
Listen:		Listen:

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 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 or University:
Collegeor University:
Other Schooling:

OTHER INFORMATION [applicable for Canadian applicants only]

Relationship to Closest Blood Relative in Canada (Canadian Citizen or Landed Immigrant):

Blood Parent	Blood Uncle/Aunt
Blood Brother or Sister	Blood Son or Daughter
Blood Nephew or Niece (22 yrs or older)	Blood Grandparent
Blood Cousin

Relative Province of Residence :

Personal Net Worth (CAD$):

Do you currently have an offer of employment from a Canadian
employer?

If your answer to the above question is "Yes" provide details here:

OTHER INFORMATION TO BE COMPLETED BY ALL APPLICANTS

Have you or your spouse or common-law partner ever:

Had any serious disease?

If your answer to the above question is "Yes" provide details here

Been convicted of or currently charged with any crime or offence in any country?

Applied previously for an immigrant visa to Canada or the United States? Visited Canada or the United States (visit,study,work)?

Are you able to obtain a visitors visa to Canada or the United States?

If your answer to the above question is "Yes" provide details here:

STATEMENT OF TRUTHFULNESS

"By pressing the Send Questionnaire button below,
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