1. Name *

First Name

Last Name

3. Phone *

(###)

###

####

4. Date of Birth *

MM

DD

YYYY

10. Have you ever overstayed a visa in the United States? *

Yes

No

11. Have you ever worked in the U.S. without authorization? *

Yes

No

12. Have you ever been denied a visa, petition, or entry to the U.S.? *

Yes

No

13. Have you ever been ordered deported, removed, or excluded from the U.S.? *

Yes

No

14. Can you provide proof of prior U.S. visa entries (if applicable)? *

Yes

No

15. Have you ever provided false or misleading information in any previous immigration applications? *

Yes

No

16. Have you ever been arrested, charged, or convicted of any crime, including driving under the influence (DUI)? *

Yes

No

17. Have you ever been involved in activities related to drug trafficking, fraud, or crimes involving moral turpitude? *

Yes

No

18. Have you ever been suspected of terrorism, espionage, or other security-related activities? *

Yes

No

19. Do you have any communicable diseases that may pose a public health risk (e.g., tuberculosis)? *

Yes

No

23. Are you comfortable with all the job requirements and do you authorize Ventureen LLC to represent your profile to its client? *

Yes

No