美国移民DS260表全文English

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PersonalInformation1

OMBCONTROLNUMBER:

1405-0185

FORMNUMBER:

DS-260

EXPIRATIONDATE:

01/31/2016

ESTIMATEDBURDEN:

120MIN

NOTE:Dataonthispagemustmatchtheinformationasitiswritteninyourpassportortraveldocuments.

Surnames

GivenNames

FullNameinNativeAlphabet

Haveyoueverusedothernames<i.e.,maiden,religious,professional,alias,etc.>?

〔yes<no>

Sex

<male>female>

CurrentMaritalStatus

DateofBirth

<Format:DD-MMM-YYYY>

CityofBirth

State/ProvinceofBirth

Country/RegionofBirth

PersonalInformation2

Country/RegionofOrigin<Nationality>

DocumentType

DocumentID

Country/AuthoritythatIssuedDocument

IssuanceDate

<Format:DD-MMM-YYYY>

ExpirationDate

<Format:DD-MMM-YYYY>

Doyouholdorhaveyouheldanynationalityotherthantheoneyouhaveindicatedabove?

<yes><no>

PresentAddress

StreetAddress<Line1>

StreetAddress<Line2>*Optional

City

State/Province

PostalZone/ZIPCode

Country/Region

StartedLivingHere

<Format:MMM-YYYY>

PreviousAddresses

Haveyoulivedanywhereotherthanthisaddresssincetheageofsixteen?<Dateyouturnedsixteen:23-Mar-2001>

<yes><no>

StreetAddress<Line1>

StreetAddress<Line2>*Optional

City

State/Province

PostalZone/ZIPCode

Country/Region

StartedLivingHere

<Format:MMM-YYYY>

ToDate

<Format:MMM-YYYY>

Phone

PrimaryPhoneNumber

SecondaryPhoneNumber

WorkPhoneNumber

Email

EmailAddress

MailingandPermanentAddressInformation

IsyourMailingAddressthesameasyourPresentAddress?

<yes><no>

PermanentAddress

PleaseprovidethefollowinginformationonwhereyouintendtoliveafterarrivalintheUnitedStates.

Nameofpersoncurrentlylivingataddress

U.S.StreetAddress<Line1>

U.S.StreetAddress<Line2>*Optional

City

State

ZIPCode

PhoneNumber

IsthisaddresswhereyouwantyourPermanentResidenceCard<GreenCard>mailed?

<yes><no>

FamilyInformation:Parents

Father

Surnames

GivenNames

DateofBirth

<Format:DD-MMM-YYYY>

PlaceofBirth

City

State/Province

Country/Region

Isyourfatherstillliving?

<yes><no>

YearofDeath

CurrentAddress

StreetAddress<Line1>

StreetAddress<Line2>*Optional

City

State/Province

PostalZone/ZIPCode

Country/Region

Mother

SurnamesatBirth

GivenNames

DateofBirth

<Format:DD-MMM-YYYY>

City

State/Province

Country/Region

Isyourmotherstillliving?

<yes><no>

YearofDeath

Isyourmother'saddressthesameasyourfather's?

<yes><no>

CurrentAddress

StreetAddress<Line1>

StreetAddress<Line2>*Optional

City

State/Province

PostalZone/ZIPCode

Country/Region

FamilyInformation:PreviousSpouse

NOTE:Pleaseprovidethefollowinginformationonallofyourpreviousspouses,includingthosedeceased.

Doyouhaveanypreviousspouses?

<yes><no>

FamilyInformation:Children

Doyouhaveanychildren?

<yes><no>

PreviousU.S.TravelInformation

HaveyoueverbeenintheU.S.?

<yes><no>

HaveyoueverbeenissuedaU.S.Visa?

*yes><no>

HaveyoueverbeenrefusedaU.S.Visa,beenrefusedadmissiontotheUnitedStates,orwithdrawnyourapplicationforadmissionattheportofentry?

<yes><no>

PresentWork/Education/TrainingInformation

PrimaryOccupation

PresentEmployerorSchoolName

PresentEmployerorSchooladdress:

StreetAddress<Line1>

StreetAddress<Line2>*Optional

City

State/Province

PostalZone/ZIPCode

Country/Region

Doyouhaveotheroccupations?

<yes><no>

nwhichoccupationdoyouintendtoworkintheU.S.?

Providethefollowinginformation:

SpecifyOther

PreviousWork/Education/TrainingInformation

Wereyoupreviouslyemployed?

<yes><no>

Haveyouattendedanyeducationalinstitutionsatasecondarylevelorabove?

<yes><no>

AdditionalWork/Education/TrainingInformation

Haveyoueverservedinthemilitary?

<yes><no>

Haveyoubelongedto,contributedto,orworkedforanyprofessional,social,orcharitableorganization?

<yes><no>

Doyouhaveanyspecializedskillsortraining,suchasfirearms,explosives,nuclear,biological,orchemicalexperience?

<yes><no>

ExplainSkillsorTraining

Haveyoueverservedin,beenamemberof,orbeeninvolvedwithaparamilitaryunit,vigilanteunit,rebelgroup,guerrillagroup,orinsurgentorganization?

<yes><no>

Explain

Canyouspeakand/orreadlanguagesotherthanyournativelanguage?

<yes><no>

Listthelanguagesthatyouspeakand/orread:

PetitionerInformation

Petitionerismy

Petitioner

PetitionerSurnames

PetitionerGivenNames

AddressandPhoneNumberofPetitioner

StreetAddress<Line1>

StreetAddress<Line2>*Optional

City

State/Province

PostalZone/ZIPCode

Country/Region

Telephone

Mobile/CellTelephone

EmailAddress

SecurityandBackground:MedicalandHealthInformation

Doyouhaveacommunicablediseaseofpublichealthsignificancesuchastuberculosis<TB>?

<yes><no>

DoyouhavedocumentationtoestablishthatyouhavereceivedvaccinationsinaccordancewithU.S.law?

<yes><no>

Doyouhaveamentalorphysicaldisorderthatposesorislikelytoposeathreattothesafetyorwelfareofyourselforothers?

<yes><no>

Areyouorhaveyoueverbeenadrugabuseroraddict?

<yes><no>

SecurityandBackground:CriminalInformation

Haveyoueverbeenarrestedorconvictedforanyoffenseorcrime,eventhoughsubjectofapardon,amnesty,orothersimilaraction?

<yes><no>

Explain

Haveyoueverviolated,orengagedinaconspiracytoviolate,anylawrelatingtocontrolledsubstances?

<yes><no>

Areyouthespouse,son,ordaughterofanindividualwhohasviolatedanycontrolledsubstancetraffickinglaw,andhaveknowinglybenefitedfromthetraffickingactivitiesinthepastfiveyears?

<yes><no>

AreyoucomingtotheUnitedStatestoengageinprostitutionorunlawfulcommercializedviceorhaveyoubeenengagedinprostitutionorprocuringprostituteswithinthepast10years?

<yes><no>

Haveyoueverbeeninvolvedin,ordoyouseektoengagein,moneylaundering?

<yes><no>

Explain

HaveyouevercommittedorconspiredtocommitahumantraffickingoffenseintheUnitedStatesoroutsidetheUnitedStates?

<yes><no>

Explain

Haveyoueverknowinglyaided,abetted,assisted,orcolludedwithanindividualwhohasbeenidentifiedbythePresidentoftheUnitedStatesasapersonwhoplaysasignificantroleinasevereformoftraffickinginpersons?

<yes><no>

Explain

Areyouthespouse,son,ordaughterofanindividualwhohascommittedorconspiredtocommitahumantraffickingoffenseintheUnitedStatesoroutsidetheUnitedStatesandhaveyouwithinthelastfiveyears,knowinglybenefitedfromthetraffickingactivities?

<yes><no>

Explain

SecurityandBackground:SecurityInformation1

Doyouseektoengageinespionage,sabotage,exportcontrolviolations,oranyotherillegalactivitywhileintheUnitedStates?

<yes><no>

Explain

DoyouseektoengageinterroristactivitieswhileintheUnitedStatesorhaveyoueverengagedinterroristactivities?

<yes><no>

Explain

Haveyoueverordoyouintendtoprovidefinancialassistanceorothersupporttoterroristsorterroristorganizations?

<Yes><no>

Explain

Areyouamemberorrepresentativeofaterroristorganization?

<yes><no>

Haveyoueverordered,incited,committed,assisted,orotherwiseparticipatedingenocide?

<yes><no>

Explain

Haveyouevercommitted,ordered,incited,assisted,orotherwiseparticipatedintorture?

<yes><no>

Explain

Haveyoucommitted,ordered,incited,assisted,orotherwiseparticipatedinextrajudicialkillings,politicalkillings,orotheractsofviolence?

<yes><no>

Explain

Haveyoueverengagedintherecruitmentofortheuseofchildsoldiers?

<yes><no>

Explain

Haveyou,whileservingasagovernmentofficial,beenresponsibleforordirectlycarriedout,atanytime,particularlysevereviolationsofreligiousfreedom?

<yes><no>

Explain

SecurityandBackground:SecurityInformation2

AreyouamemberoforaffiliatedwiththeCommunistorothertotalitarianparty?

<yes><no>

HaveyoueverdirectlyorindirectlyassistedorsupportedanyofthegroupsinColombiaknownastheRevolutionaryArmedForcesofColombia<FARC>,NationalLiberationArmy<ELN>,orUnitedSelf-DefenseForcesofColombia<AUC>?

<yes><no>

Haveyouever,throughabuseofgovernmentalorpoliticalpositionconvertedforpersonalgain,confiscatedorexpropriatedpropertyinaforeignnationtowhichaUnitedStatesnationalhadclaimofownership?

<yes><no>

Areyouthespouse,minorchild,oragentofanindividualwhohasthroughabuseofgovernmentalorpoliticalpositionconvertedforpersonalgain,confiscatedorexpropriatedpropertyinaforeignnationtowhichaUnitedStatesnationalhadclaimofownership?

<yes><no>

Haveyoueverbeendirectlyinvolvedintheestablishmentorenforcementofpopulationcontrolsforcingawomantoundergoanabortionagainstherfreechoiceoramanorawomantoundergosterilizationagainsthisorherfreechoice?

<yes><no>

HaveyoueverdisclosedortraffickedinconfidentialU.S.businessinformationobtainedinconnectionwithU.S.participationintheChemicalWeaponsConvention?

<yes><no>

Areyouthespouse,minorchild,oragentofanindividualwhohasdisclosedortraffickedinconfidentialU.S.businessinformationobtainedinconnectionwithU.S.participationintheChemicalWeaponsConvention?

<yes><no>

SecurityandBackground:ImmigrationLawViolationsInformation1

Haveyoueversoughttoobtainorassistotherstoobtainavisa,entryintotheUnitedStates,oranyotherUnitedStatesimmigrationbenefitbyfraudorwillfulmisrepresentationorotherunlawfulmeans?

<yes<no>

SecurityandBackground:MiscellaneousInformation1

HaveyoueverwithheldcustodyofaU.S.citizenchildoutsidetheUnitedStatesfromapersongrantedlegalcustodybyaU.S.court?

<yes><no>

HaveyoueverintentionallyassistedanotherpersoninwithholdingcustodyofaU.S.citizenchildoutsidetheUnitedStatesfromapersongrantedlegalcustodybyaU.S.court?

<yes><no>

HaveyouvotedintheUnitedStatesinviolationofanylaworregulation?

<yes><no>

HaveyoueverrenouncedUnitedStatescitizenshipforthepurposeofavoidingtaxation?

<yes><no>

Haveyouattendedapublicelementaryschoolorapublicsecondaryschoolonstudent<F>statusafterNovember30,1996withoutreimbursingtheschool?

<yes><no>

DoyouseektoentertheUnitedStatesforthepurposeofperformingskilledorunskilledlaborbuthavenotyetbeencertifiedbytheSecretaryofLabor?

<yes><no>

AreyouagraduateofaforeignmedicalschoolseekingtoperformmedicalservicesintheUnitedStatesbuthavenotyetpassedtheNationalBoardofMedicalExaminersexaminationoritsequivalent?

<yes><no>

SecurityandBackground:MiscellaneousInformation2

AreyouahealthcareworkerseekingtoperformsuchworkintheUnitedStatesbuthavenotyetreceivedcertificationfromtheCommissiononGraduatesofForeignNursingSchoolsorfromanequivalentapprovedindependentcredentialingorganization?

<yes><no>

AreyoupermanentlyineligibleforU.S.citizenship?

<yes><no>