If you are an employer seeking to sponsor one or more Registered Nurses, a separate questionnaire should be completed for each RN.

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1 REGISTERED NURSE IMMIGRATION CONSULTATION QUESTIONNAIRE Registered Nurses who graduated from nursing schools overseas and interested in migrating to the United States to work should complete the questionnaire below. The questionnaire and a consultation fee should be mailed to any of our offices in Washington. Upon receipt of the questionnaire, our attorneys will review the same and contact the applicant with further instructions on how to obtain a job in the nursing field as well as visa to the United States. The information required of the applicant in the form should be about the Registered Nurse who is seeking United States Green Card or Permanent Residence. It is important that the form be completed in its entirety. If you are an employer seeking to sponsor one or more Registered Nurses, a separate questionnaire should be completed for each RN. If you are helping a relative immigrate to the United States, the applicant s information should be about the Registered Nurse. You may consult with our offices by , telephone or in-person. If you desire consultation, please provide your address and remember to check your mail for our response to your questions and the steps you need to take to secure a job and visa to the United States. Our addresses are listed on the contact page of our web site.

2 INFORMATION ABOUT YOU Full Name: Last First Middle Date of Birth: Day Month Year Place of Birth: City Province/State Country Current Address in the U.S.: Number & Street City, State & Zip Code Phone #/Fax # Address INFORMATION ABOUT YOUR FAMILY SPOUSE Full Name: Last First Middle Date of Birth: Day Month Year Place of Birth: City Province/State Country Date of Marriage: Day Month Year Place of Marriage: City Province /State Country

3 INFORMATION ABOUT YOUR CHILDREN (UNMARRIED AND UNDER 21 YEARS OF AGE) Full Name (Last, First & Middle) EDUCATIONAL BACKGROUND: Please list all your education anywhere in the world: High School: Number of years Date & Year of Graduation College/University: School/Country Major/Degree & Year of graduation College/University: School/Country Major/Degree & Year of graduation EMPLOYMENT HISTORY: Employer: Name Job Title Address: Number & Street City/State/Country Period of Employment: Date of Hire Date Left Salary

4 Employer: Name Job Title Address: Number & Street City/State/Country Period of Employment: Date Hired Date Left Salary JOB QUALIFICATIONS: List the professional licenses or certificates you possess, from any State or Country: Certificates: Name of Cert. Issuing Inst./State/Country Year Issued Name of Cert. Issuing Inst./State/Country Year Issued Name of Cert. Issuing Inst./State/Country Year Issued Name of Cert. Issuing Inst./State/Country Year Issued Licenses:

5 OTHER INFORMATION: 1. Have you, your spouse or minor children ever claimed to be a United States citizen or Have you ever used any other name in the past? If yes, please state in detail:

6 OTHER INFORMATION CONTINUED: 2. Have you and/or your spouse ever been arrested, charged or convicted of any crime? If yes, please give details including case number, name of court, state/country and disposition. 3. Have you or your spouse ever been denied a visa to come to the United States? If yes, please explain. 4. During the past three years, have you and/or your spouse filed an income tax return in the United States? If yes, indicate the years. IN THE BOX BELOW PLEASE STATE YOUR IMMIGRATION RELATED QUESTIONS: Signature address Phone/Fax #

7 HOW TO APPLY REGISTERED NURSE IMMIGRATION CONSULTATION APPLICATION AND PAYMENT METHOD Complete and sign all application in the space provided. Additional child or children can be added at the back of the application form. APPLICABLE FEES FOR SERVICES A none-refundable consultation fee of $ is charged per application. (This amount is credited toward the overall service charge should our office be retained within 30 days from the day of the consultation For the completion of Registered Nurse USA Visa/Permanent Residence Application process). PAYMENT METHOD Payment should be made in US Dollars through the following method: Money Order Travelers Checks International Money Order International Travelers Checks Bank Draft Cashier s Checks American Express Discover Card Master Card Euro Card Visa Please note that Money Order, Travelers Checks, Bank Draft and Cashiers Checks should be made in USA Dollars drawn from a bank in the United States. If you are paying by Credit Cards, you may pay on-line or complete the attached Payment Authorization Form. MAILING ADDRESS Completed application forms, Consultation fees and payment authorization forms (If paying by Credit Card) should be mailed to our offices: WASHINGTON DC OFFICE OGOLO & ASSOCIATES Attorneys at Law th Street, NW, Ste 100 Washington, D.C

8 (Complete only if paying by credit card) REGISTERED NURSE IMMIGRATION CONSULTATION PAYMENT AUTHORIZATION FORM CREDIT CARD Credit Card Number Visa Euro Card Master Card Discover Card American Express Expiration Date NAME ON THE CARD (Month) (Year) BILLING ADDRESS (If different from Address of applicant) TERMS AND CONDITIONS: I agree to pay the Law Offices of Ogolo & Tokunboh, P.C. Consultation fee for services related to USA Registered Nurse VISA / Permanent Residence Program. I further acknowledge that the Law Offices of Ogolo & Tokunboh, P.C. does not guarantee that I will receive a Permanent USA Residence/Work Permit or visa, but will only provide me/us with the opportunity to consult and or apply for the USA Registered Nurse VISA/Permanent Residence program. I understand that I cannot claim a refund for fees paid for consultation and that the consultation fee will count toward the overall application fee should I decide to retain the Law Offices of Ogolo & Tokunboh PC within 30 days of the consultation for the entire application process leading to USA Registered Nurse VISA / Permanent Residence. By signing below, I accept these terms and conditions and agree to pay the above processing fee according to my card issuer agreement. X CARD HOLDER S SIGNATURE Return Completed Application and Fee to any of the following offices: DATE WASHINGTON, DC OFFICE OGOLO & ASSOCIATES Attorneys at Law th Street, NW, Ste 100 Washington, D.C