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  1. INFORMATION ABOUT APPOINTMENT WITH KOLKO & ASSOCIATES

  2. Date of Appointment:
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  3. INFORMATION ABOUT YOU

  4. Name
  5. Last:
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    First:
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    Middle:
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  6. Other names used (including maiden name):
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    Sex:
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  7. E-mail address:
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  8. Current Address in U.S.
  9. Number and Street:
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  10. City:
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    State:
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    Zip:
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  11. Last Address Outside of U.S.
  12. Number and Street:
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  13. City:
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    State/Province:
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    Postal Code:
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  14. Country:
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  15. Home Phone:
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    Work Phone:
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    Hours we can call:
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    Hours we can call:
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    Fax Number:
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    Pager/Cell Phone:
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    Social Security No:
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    Citizen of:
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    Date and Place of Birth: Passport Information:
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    Passport Country:
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    City or Town:
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    Passport Number:
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    State or Province:
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    Expiration Date:
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    Country:
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  16. What type of immigration assistance are you seeking?
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  17. FAMILY INFORMATION

  18. Husband or Wife
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  19. Spouse's Name
  20. Last:
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    First:
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    Middle:
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  21. Other names used (including maiden name):
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  22. Current Address (put "same" if you live together):
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  23. Date and Place of Birth:
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    Social Security Number:
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    Date and Place of Marriage:
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    Alien ("A") Number:
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    Citizen of:
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    Immigration Status:
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    Applying with you?
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    Expiration Date:
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  24. Children
  25. Total Number of Sons and Daughters:
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  26. NameSexDate & Country of BirthCitizen ofImmigration StatusExpiration DateApplying with You?
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  27. Parents
  28. NameCountry of BirthCitizen ofImmigration Status
    Your Father:
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    Your Mother*:
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    Spouse's Father:
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    Spouse's Mother*:
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    * Use Mother's Maiden Name
  29. Previous Marriages
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  30. NameDate of MarriageCountry of MarriageKids?Reason for Termination of MarriageDate of Termination of MarriageCountry of Termination of Marriage
    Your's:
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    Spouse's:
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  31. IMMIGRATION HISTORY

  32. Current Immigration Status:
    Date Status Expires:
    Alien ("A") Number:
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    Date of First Entry into U.S.:
    Last Entry into U.S.:
    I-94 Number:
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  33. Check every type of immigration status that you have ever held and provide the dates:
  34. Immigration StatusDate(s)Immigration StatusDate(s)
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  36. Check each one that you or your spouse have ever applied for or been the beneficiary of:
  37. Y(you) or S(Spouse) Date Filed Sponsor Attorney Result
    Green Card
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    Immigrant petition
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    Labor certification
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    Asylum
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    Amnesty
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    38. Other:
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  39. 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:
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  40. EMPLOYMENT HISTORY

  41. Current Employer (or Employer Petitioning on Your Behalf)
  42. Employer:
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  43. Address:
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  44. Job Title:
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    Salary:
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  45. Date of Hire:
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    Are you related to your employer?
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  46. May we contact your employer?
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  47. If yes, whom may we contact:
  48. Name Title Department Phone Number
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  49. Employment in Last Five Years (anywhere in the world)
  50. Job Title Employer Country Duration
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  51. JOB QUALIFICATIONS
  52. List the professional licenses or certifications you possess, from any state or country:
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  53. How many years of experience do you have in your position or field?
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  54. EDUCATIONAL BACKGROUND

  55. Please list all your education anywhere in the world:
  56. Level School/Country Degree & Major Number of Years Graduate?
    College/University:
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    College/University:
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    Other Schooling:
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  57. OTHER INFORMATION

  58. Have you ever been charged, cited, 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?
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  59. If yes, please explain in detail:
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  60. 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?
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  61. If yes, please explain in detail:
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  62. Have you ever been denied a visa to come to the United States?
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  63. If yes, when and what kind of visa:
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  64. During what years, if any, have you filed an Income Tax Return with the IRS?
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  65. If you ever had an Employment Authorization Card issued by the Immigration, give number(s) and validity dates:
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  66. Is there anything, not already covered in this form, that you feel we should know?
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  67. STATEMENT OF TRUTHFULNESS

  68. "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."
  69. Type your name
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    Type today's date
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Kolko & Casey, P.C.
5251 South Quebec Street
Suite 200
Greenwood Village, Colorado 80111

Call us today:
303-371-1822

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Kolko & Casey, P.C. is a full service immigration and naturalization law firm providing professional legal services to individuals and businesses throughout Colorado, the Rocky Mountain West, the United States, and the World. Our professional staff speaks English, Spanish, Korean, and Portuguese and we can arrange for translators in any other language.