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PART 1/PARTE 1
Name/Nombre:
Citizen/Ciudadano the State/Estado:
Address/Direccion:
City/Ciudad:
State/Estado:
Zip/Codigo Postal:
Telephone no.:/Telefono:
Cell/Cellular:
Education/Nivel de Educacion:
Place of Birth/Lugar de Nacimiento:
US Citizen/Ciudadano Americano?:
Date you entered the USA/Fecha que entro a USA:
PART 2/PARTE 2.
Criminal Record/ Record Criminal:
Date/Fecha:
Charges/Cargos:
Penalties/Castigo:
PART 3/PARTE 3
Employer Name/Nombre de su Empleador:
Address/Dirreccion:
Telephone no.:/Telefono:
Does your employer know about your legal status/ Su empleador sabe de su situacion legal?:
Submit
