Intake Form for Employee for PERM

1 - Personal Information

First Name *

Last Name *

a. If you have used other names than the one above, or changed your name, list them here:

2. Address

3. Phone *

4. Email *

5. Date of Birth *

6. City & Country of Birth

7. Present Citizenship/Nationality

U.S. Immigration Info (If in the U.S.)

8. Date of last entry

9. Place of last entry

10. Present visa status

Date of Expiration for Present Visa

11. Number on I-94

Date of Expiration for I-94

12. Has another employer ever filed an I-140 on your behalf?

No Yes

13. Has a family member ever filed an I-130 on your behalf?

No Yes

14. Alien Registration Number A# (if applicable)

15. Social Security Number (if applicable)

16. Spouse and Children (Select to add details)

Spouse Child 1 Child 2 Child 3

2 - Educational Background

What is your highest completed degree?

Bachelor's

Master's

PhD or equivalent

Other:

EDUCATION: list all colleges/universities attended, address, years attended, and degree received (if no college degree, list high school):

3 - Professional Background

Have you ever worked in the U.S.?

No Yes

4 - Work Experience

Start with present job and list all jobs including jobs abroad or prior to most recent degree.

Company 1 (Current) Company 2 Company 3 Company 4

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PERM Employee Intake Form