IDENTIFICATION

_ Driver's license or State issued I.D.

_ Social Security Card

_ Legal Permanent Residency Card

TRIPS OUTSIDE THE U.S.(month/day/year)

_Dates of all trips, over 24 hours, outside the United States for the last 5 years.

_ Destination traveled to

RESIDENCE (last 5 years)               month & year

_Complete addresses for the past five years.

_Dates moved in and moved out of the residence.

EMPLOYMENT (last 5 years)      month & year

_Names, dates, and addresses of all employers for the past five years.

_Title of positions held.

CRIMINAL RECORD

_Date and location of any arrest.

_Nature of the offense.

_Outcome of the case.

_Police report and court disposition.

CHILDREN

_Names of all children.

_Date of birth.

_Country of birth.

_Number of all children.

_City and state of where they live.

MARRIAGE(S)

Present Spouse:

_Name.

_Address.

_Country of Birth.

_Date of Birth.

_Date of marriage by Law.

_Social Security Number.

_Number from spouse's green card.

_Date and Place of Naturalization.

_Immigration status

MARRIAGE(S) Cont.

Former Spouse:

_Name.

_Date of marriage.

_Date marriage ended.

_Divorce/death certificate.

_Immigration status.

If your spouse was previously married, the same information is required about your spouse's ex-husband/ex-wife.

SELECTIVE SERVICE

_Selective Service Number and date registered.

All males born after 1960 and in the US between the ages of 18 to 26, must register with selective service.

To verify your registration status or if you are between the ages of 18 to 26 and want to register, call (847) 688-6888 or visit www.sss.gov