Name(First, Middle, Last):
E-Mail Address:
Mailing Address1:
Address2:
City:
State:
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Country:
ZIP/Postal Code:
Home Phone:
Work Phone(Optional):
Do not list if you do not want to be contacted at work.
Fax:
Country of Residence:
Country of Citzenship:
Highest Level of Education:
Field of Studies:
Years Worked:
Summary of Work Experience:
Jobs Held:
Do you own a business? (Describe Briefly):
How much capital will you invest in a US Business?:
Do you have management experience?:
Are you a manager of a company that will establish a business in the U.S.? (Explain):
Do you have close family members who are U.S Citizens? Relationship?:
Are you officially recognized by your peers for your professional achievements? (Briefly Explain):
Are you a highly skilled professional? Bachelors Degree or equivalent. (Give Details):
What job have you been offered by a U.S. employer? (Describe position offered):
Do you have extraordinary talents that could benefit the U.S.?:
Do you want to form a U.S. Corporation?:
Additional information you consider important: