EFTA00313675.pdf

Foreign Address (including post code): 142181 Russia, Klimovsk US Consulate/Embassy abroad at which you wish to apply for your visa: United States Address (if any): United States Social Security Number (if any): Have you ever had an 0-1 visa? If so, no which agency or agencies served as the petitioner (visa sponsor)? Have you ever had an H-1B or 1-1 visa, or no any other US visa issued to you? Have you ever had a US visa application no denied, a US visa revoked, or have you been denied entry into the US? If yes, please explain. Has anyone (including yourself, a family ng member, spouse or employer) ever filed a Green Card application for you? Have you ever been arrested, charged with no or convicted of a criminal offence (whether in the US or in any other country)? If yes, please provide details. Do you have any dependents (spouse and/ mi or child(ren))? If yes, please provide details. Please also provide copies of the following: • Color copy of your passport biographic data page (page with your photo). • Copies of ALL current and past USCIS Approval Notices for ALL non-immigrant (B-2, H-1B, 0-1, etc.) visas. • Copies of ALL current and past non-immigrant (B-2, F, H-1B, E, L, 0-1, etc.) ta vi 'tamps in your current gag expired passports. This the page affixed into your passport by EFTA00313675