PART B. STATEMENT OF QUALIFICATIONS OF ALIEN
FOR ADVICE CONCERNING REQUIREMENTS FOR ALIEN EMPLOYMENT CERTIFICATION: If alien is in the U.S., contact nearest office of
Immigration and Naturalization Service. If alien is outside U.S., contact nearest U.S. Consulate.
IMPORTANT: READ ATTACHED INSTRUCTIONS BEFORE COMPLETING THIS FORM.
Print legibly in ink or use a typewriter. If you need more space to fully answer any questions on this form, use a separate sheet. Identify
each answer with the number of the corresponding question. Sign and date each sheet.
1. Name of Alien (Family name in capital letters)
First name
Middle name
Maiden name
2. Present Address (No., Street, City or Town, State or Province and ZIP code)
Country
3. Type of Visa (If in U.S.)
4. Alien's Birthdate
(Month, Day, Year)
5. Birthplace (City or Town, State or Province)
Country
6. Present Nationality or
Citizenship (Country)
7. Address in United States Where Alien Will Reside
8. Name and Address of Prospective Employer if Alien has job offer in U.S.
9. Occupation in which
Alien is Seeking Work
10. "X" the appropriate box below and furnish the information required for the box marked
City in Foreign Country
Foreign Country
City
State
a.
b.
Alien will apply for a visa abroad at the American
Consulate in
Alien is in the United States and will apply for adjust-
ment of status to that of a lawful permanent resident
in the office of the Immigration and Naturalization
Service at
11. Names and Addresses of Schools, Col-
leges and Universities Attended (Include
trade or vocational training facilities)
Field of
Study
Degrees or Certificates
Received
FROM
TO
Month
Year
Month
Year
SPECIAL QUALIFICATIONS AND SKILLS
12. Additional Qualifications and Skills Alien Possesses and Proficiency in the use of Tools, Machines or Equipment Which Would Help Establish if
Alien Meets Requirements for Occupation in Item 9.
13. List Licenses (Professional, journeyman, etc.)
14. List Documents Attached Which are Submitted as Evidence that Alien Possesses the Ed