14. Do You Have Any Specialized Skills or Training, Including Firearms,
Explosives, Nuclear, Biological, or Chemical Experience?
12. Not Including Current Employer, List Your Last Two Employers
9. List All Countries You have Entered in the Last Ten Years
(Give the Year of Each Visit)
PLEASE TYPE OR PRINT YOUR ANSWERS IN THE SPACE PROVIDED BELOW EACH ITEM
PLEASE ATTACH AN ADDITIONAL SHEET IF YOU NEED MORE SPACE TO CONTINUE YOUR ANSWERS
U.S. Department of State
SUPPLEMENTAL NONIMMIGRANT VISA APPLICATION
15. Have You Ever Performed Military Service?
Approved OMB 1405-0134
Estimated Burden 1 Hour*
1. Last Name(s) (List all Spellings)
2. First Name(s) (List all Spellings)
3. Full Name (In Native Alphabet)
16. Have You Ever Been in an Armed Conflict, Either as a Participant or Victim?
13. List all Professional, Social and Charitable Organizations to Which You
Belong (Belonged) or Contribute (Contributed) or with Which You Work
If Yes, Give Name of Country, Branch of Service, Rank/Position, Military Specialty, and Dates of
18. Have You Made Specific Travel Arrangements?
If YES, please provide a complete itinerary for your travel, including arrival/departure dates,
flight information, specific location you will visit, and a point of contact at each location.
Course of Study
Dates of Attendance
Name of Institution
4. Clan or Tribe Name (If Applicable)
5. Spouse's Full Name (If Married)
6. Father's Full Name
7. Mother's Full Name
11. Have You Ever Lost a
Passport or Had One Stolen?
8. Full Name and Address of Contact Person or Organization in the United States (Include Telephone Number)
10. List All Countries That Have Ever Issued You a
If YES, please explain.
Dates of Employment
Paperwork Reduction Act Statement