PERM Questionnaire

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Sponsoring Employer

Employee ID

Case Number

Copy the Case Number provided in the initiation email here.

BIOGRAPHIC INFORMATION

Last Name/Surname

Given Name(s)

Email (Use the address assigned by your employer)

Gender

MaleFemale

Date of Birth

mm/dd/yyyy

City/Town/Village of Birth

State or Province of Birth

Country of Birth

Country of Citizenship

Marital Status

Do you have any children?

Yes

Passport Number

Expiration Date

mm/dd/yyyy Note: Must be valid on the date of filing

Country of Issuance

Is anything noted on the Observation page of your passport?

Yes

U.S. Social Security Number

9 digits (no dashes, no spaces)

Alien Number (if any)

9 digits (no dashes or spaces)

CURRENT RESIDENTIAL ADDRESS

If you are NOT currently residing in the US, leave this section blank and skip to next section (Foreign Residential Address).

Street Name and Number

Apartment Number

City

State

Zip Code

U.S. Home Phone

10 Digits (no spaces no dashes)

Mobile Phone

10 Digits (no spaces no dashes)

FOREIGN RESIDENTIAL ADDRESS

Street Name and Number

Apartment No.

City

State/Province

Country

Zip/Pin Code

Page 2

U.S. IMMIGRATION INFORMATION

Nonimmigrant Visa Number

The visa number (usually 8 characters) can be found on your visa in red, located towards the bottom right side of the visa. Please DO NOT put the "Control Number" in this field.

Date Visa Issued

mm/dd/yyyy

Date Visa Expires/Expired

mm/dd/yyyy

Do you currently live outside the United States?

Yes

U.S. IMMIGRATION INFORMATION

Current Status

Leave blank if outside U.S.

Date of Last Arrival

mm/dd/yyyy

In what status did you last enter the U.S.?

City/State of Last Entry

Record the CITY and STATE where you were inspected by U.S. Immigration, not your final U.S. destination

I-94 Number

11 digits (include leading zero, if applicable)

Date I-94 Expires

mm/dd/yyyy: Leave blank if outside U.S.

U.S. ENTRY/EXIT INFORMATION

List dates in chronological order beginning with your most recent arrival.

U.S. Arrival

U.S. Departure

Class of Admission (e.g. H-1B, L-1B)

U.S. Arrival

U.S. Departure

Class of Admission (e.g. H-1B, L-1B)

U.S. Arrival

U.S. Departure

Class of Admission (e.g. H-1B, L-1B)

Has anyone ever filed an immigrant visa petition for you (e.g. Form I-140 or Form I-130)?

Yes

If you have not been the beneficiary of an employee's filed immigrant petition (I140) or family member's filed immigrant petition (I130), the answer to this question is "No." Do not answer the question based on the I140 immigrant petition that your employer is about to file for you.

Have you ever filed for U.S Permanent Residence (Form I-485 or DS-230)?

Yes

Have you ever been the subject of exclusion or deportation proceedings?

Yes

Have you ever been arrested?

Yes

Have you ever been denied ANY immigration benefit?

Yes

EDUCATION

Name of College/University

Address of University (Street Name and Number)

City

State/Province

Zip/Pin Code

Country

Degree Awarded

Field of Study/Major

e.g., Mechanical Engineering, Computer Science

Date Awarded

mm/dd/yyyy

EMPLOYMENT

Please do not rush to complete your questionnaire as this can lead to errors and processing delays both at this stage and later during your GC process. Carefully consider the following guidance that G&A has prepared especially to help you complete this section. Be assured that G&A will guide you further once your questionnaire and intake documents are received in our office.

I have read this section (1 of 4)

How to write a job description for a PERM GC case. Your job description will be evaluated by a Department of Labor officer who might not be familiar with your occupation, your company, or your industry. Therefore, Goel & Anderson recommends that you:

Describe your job in 100-200 words to provide the appropriate amount of detail.
Use common, but descriptive language.

If you must use a technical term, join it with more common words. For example, "Designed backend tests and tested reports developed by Business Intelligence (BI) tools" is more informative than "Worked with BI tools." However, do not only use words that have broad applications. For example, many unrelated occupations involve "projects" or require activities like "testing." Put these kinds of words into context so that your job duties clearly identify your occupation. For example, "Conducted integration testing and backend testing for software application development projects using UNIX and Oracle."

I have read this section (2 of 4)

Why don’t you ask for my resume? Unlike a resume that must persuade a prospective employer that you are the best candidate, the PERM application where your job descriptions will appear must inform the US government that you meet the job offer's minimum requirements. Put another way, your PERM job description has a different purpose and audience than a resume. The most effective job descriptions are objective (impartial) and easily understood by someone outside of your field.

I have read this section (3 of 4)

Other Important Tips:

This Form will accept six jobs, including your current job. After you have entered your current job, enter your past jobs in reverse chronological order. Do not attempt to add additional jobs in the Form.
If you have worked for an employer both inside the U.S. and outside the U.S., list the U.S. employment separate from the employment outside the U.S.
To maintain confidentiality, avoid using project or client names.
You do not need to break down your employment by project unless the projects required you to perform significantly (+50%) different duties.
So that your data transmits correctly, enter your job descriptions in paragraphs (not numbered or bulleted lists) and do not use ALL CAPS.
Once you have entered your employment dates, verify that they are consistent with your travel history recorded in the previous section of this questionnaire.

I have read this section (4 of 4)

Current Employer

Current Employer

If your Employer's business name has changed recently, record the new name.

Address of your current Employer (headquarters)

Include your employer's complete address (with city, state, country, and postal code)

Occupation/Job Title

List your internal designation, not your project role.

Current Annual Salary

Job Duties

Include all technologies or tools used

Employed in Current Position Since

Please provide the date in month, day, year format only

Supervisor's Full Name

Supervisor's Phone Number

If unknown, provide the employer's corporate phone number

Employment History

Previous Employer Name

Previous Employer Address (headquarters)

Include your employer's complete address (with city, state, country, and postal code)

Occupation/Job Title

List your internal designation, not your project role.

Employed From

Please provide the date in month, day, year format only

Employed To

Please provide the date in month, day, year format only

Job Duties

Include all technologies or tools used; and any industry-recognized certifications gained during this employment period.

Supervisor's Name

Supervisor's phone number

If unknown, provide the employer's corporate phone number

Hours (per week)

Employment History

Previous Employer Name

Previous Employer Address (headquarters)

Include your employer's complete address (with city, state, country, and postal code)

Occupation/Job Title

List your internal designation, not your project role.

Employed From

Please provide the date in month, day, year format only

Employed To

Please provide the date in month, day, year format only

Job Duties

Include all technologies or tools used; and any industry-recognized certifications gained during this employment period.

Supervisor's Name

Supervisor's phone number

If unknown, provide the employer's corporate phone number

Hours (per week)

Employment History

Previous Employer Name

Previous Employer Address (headquarters)

Include your employer's complete address (with city, state, country, and postal code)

Occupation/Job Title

List your internal designation, not your project role.

Employed From

Please provide the date in month, day, year format only

Employed To

Please provide the date in month, day, year format only

Job Duties

Include all technologies or tools used; and any industry-recognized certifications gained during this employment period.

Supervisor's Name

Supervisor's phone number

If unknown, provide the employer's corporate phone number

Hours (per week)

Employment History

Previous Employer Name

Previous Employer Address (headquarters)

Include your employer's complete address (with city, state, country, and postal code)

Occupation/Job Title

List your internal designation, not your project role.

Employed From

Please provide the date in month, day, year format only

Employed To

Please provide the date in month, day, year format only

Job Duties

Include all technologies or tools used; and any industry-recognized certifications gained during this employment period.

Supervisor's Name

Supervisor's phone number

If unknown, provide the employer's corporate phone number

Hours (per week)

Employment History

Previous Employer Name

Previous Employer Address (headquarters)

Include your employer's complete address (with city, state, country, and postal code)

Occupation/Job Title

List your internal designation, not your project role.

Employed From

Please provide the date in month, day, year format only

Employed To

Please provide the date in month, day, year format only

Job Duties

Include all technologies or tools used; and any industry-recognized certifications gained during this employment period.

Supervisor's Name

Supervisor's phone number

If unknown, provide the employer's corporate phone number

Hours (per week)

Page 3

Information about your spouse

SPOUSE'S BIOGRAPHIC DATA

Spouse's Last Name/Surname

Spouse's Given Name(s)

Date of Birth

mm/dd/yyyy

City/Town/Village of Birth

State or Province of Birth

Country of Birth

Country of Citizenship

Spouse's Gender

MaleFemale

Date of Marriage

mm/dd/yyyy

Place of Marriage (City and Country)

Spouse's Maiden Name

Enter spouse's surname prior to marriage

Will your spouse apply for Permanent Residence with you?

YesNoIf your non-US citizen dependent intends to apply for permanent residence together with you once you become eligible to file, the answer to this question is “Yes".

SPOUSE'S U.S. IMMIGRATION INFORMATION

Current Status

Date of Last Arrival

mm/dd/yyyy

Place of Last Entry

Record the CITY and STATE where you were inspected by U.S. Immigration, not your final U.S. destination

Spouse I-94 Number

11 digits (include leading zero, if applicable)

Date Status Expires

In what status did your spouse last enter the U.S.?

Date Visa Issued

mm/dd/yyyy

Consulate of Visa Issuance

Nonimmigrant Visa Number

The visa number (usually 8 characters) can be found on your visa in red, located towards the bottom right side of the visa. Please DO NOT put the "Control Number" in this field.

Alien Number

9 Digits (no dashes or spaces)

Spouse's U.S. Social Security Number

9 Digits (no dashes or spaces)

Passport Number

Expiration Date

mm/dd/yyyy

Country of Issuance

Is anything noted on the Observation page of your passport?

Yes

Has your spouse ever been arrested?

Yes

Has your spouse ever been denied ANY immigration benefit?

Yes

Page 4

Child Biographic Information

Child's Last Name/Surname

Child's Given Name(s)

Child's Date of Birth

mm/dd/yyyy

Child's City/Town of Birth

Child's State or Province of Birth

Child's Country of Birth

Child's Country of Citizenship

Gender

MaleFemale

Child's Marital Status

Child's Social Security Number

If none, state "None"

Child's Alien Number

If none, state "None")

Will your child apply for Permanent Residence with you?

Yes

If your non-US citizen dependent intends to apply for permanent residence together with you once you become eligible to file, the answer to this question is “Yes".

Child's U.S. Immigration Information

Child's Current nonimmigrant Status

Child 's Date of Last U.S. Entry

Place of Last Entry

Record the CITY and STATE where you were inspected by U.S. Immigration, not your final U.S. destination

Child's I-94 Number

11 digits (include leading zero, if applicable)

Date Child's Status Expires

mm/dd/yyyy

In what status did the child last enter the U.S.?

Consulate of Visa Issuance

Date Visa Issued

mm/dd/yyyy

Nonimmigrant Visa Number

The visa number (usually 8 characters) can be found on your visa in red, located towards the bottom right side of the visa. Please DO NOT put the "Control Number" in this field.

Child's Passport Number

Child's Passport Expiration Date

mm/dd/yyyy

Child's Passport Country of Issuance

Has your child ever been arrested?

Yes

Has your child ever been denied ANY immigration benefit?

Yes

Second Child's Biographic Information

Second Child's Last Name/Surname

Second Child's Given Name(s)

Second Child's Date of Birth

mm/dd/yyyy

Second Child's City/Town of Birth

Second Child's State or Province of Birth

Second Child's Country of Birth

Second Child's Country of Citizenship

Second Child Gender

MaleFemale

Second Child's Marital Status

Second Child's Social Security Number

If none, state "None"

Second Child's Alien Number

If none, state "None"

Will your child apply for Permanent Residence with you?

Yes

If your non-US citizen dependent intends to apply for permanent residence together with you once you become eligible to file, the answer to this question is “Yes".

Has your child ever been arrested?

Yes

Has your child ever been denied ANY immigration benefit?

Yes

Third Child's Biographic Information

Third Child's Last Name/Surname

Third Child's Given Name(s)

Third Child's Date of Birth

mm/dd/yyyy

Third Child's City/Town of Birth

Third Child's State or Province of Birth

Third Child's Country of Birth

Third Child's Country of Citizenship

Third Child's Gender

MaleFemale

Third Child's Marital Status

Third Child's Social Security Number

If none, state "None"

Third Child's Alien Number

If none, state "None"

Will your child apply for Permanent Residence with you?

Yes

If your non-US citizen dependent intends to apply for permanent residence together with you once you become eligible to file, the answer to this question is “Yes".

Has your child ever been arrested?

Yes

Has your child ever been denied ANY immigration benefit?

Yes

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