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Please answer the following questions in the fields provided to the best of

your ability. If you do not understand a question or if you do not know the
answer, please indicate “DNK” (Do Not Know) and simply move on. This
Questionnaire is an internal information collection tool, and not something
that we will share with others, so we will understand if you cannot answer all

Immigration Questionnaire
Leave this row blank
Sponsoring Company Name Offered Job Title Location of Employment
DNK

PERSONAL

1. Please list your full legal name:

First Name Middle Name(s) Last or Family Name


NAVEEN KUMAR KALAKOTI

2. Please list your name as given at birth:

First Name Middle Name Last or Family Name


NAVEEN KUMAR KALAKOTI

3. Please list any aliases you may have used (include maiden name, if applicable):

First Name Middle Name Last or Family Name


DNK DNK DNK

4. Please list the following information about yourself:

Date of Birth Place of Birth (City, Country) Nationality


29/08/1981 KHAMMAM,INDIA INDIAN
Gender (Male/Female) Social Security Number (if applicable)
MALE DNK DNK

5. Please list your current residential address:

Street Number and Name


DNK
City State or Province Country Postal Code
ASWARAOPETA A.P INDIA 507301

6. Please list your home addresses for the past five years, beginning with your most recent address:
Street Address City State or Province Country From To
Month/Year Month/Year
H.No:9-142, KHAMMAM(DT) A.P INDIA 1998 2008
NEAR:BUSSTAND,
ASWARAOPETA.
7. Please complete the following information.

Telephone Number Telephone Email Address Email Address Fax Number


/ Home Number / Work Home Work
08740-255753 9440875672 naveenk929@gmail.com DNK

8. IF YOU ARE PRESENTLY IN THE UNITED STATES, please provide the following information regarding your
initial entry and current immigration status. [Please note that “status” refers to the immigration classification
that you hold and is often reflected on the INS Form I-94 issued to you. “Visa” refers to the Nonimmigrant
Visa (if any) that is affixed to your passport and that was issued by a U.S. consulate.]

Date of Last Entry into Port of Entry of Form I-94 Number (11 digits) U.S. Immigration Status
U.S. (City/State) upon Entry
DNK DNK DNK DNK
Mode of Current U.S. Immigration Date Current Immigration U.S. Permanent Resident
Transportation Status Status Will Expire “A” Number
DNK DNK DNK DNK
Type of Visa You Date Current Visa Expires Place Current Visa Issued Number of Entries for
Possess which Visa is Valid
DNK DNK DNK DNK

9. Please list all languages that you speak, read, and/or write:

Language Speak Read Write


ENGLISH YES YES YES
TELUGU YES YES YES

MARITAL STATUS AND SPOUSE

10. Please provide the following information regarding your current marital status:

Current Marital Status Date of Marriage Place of Marriage Number of Times Married
DNK DNK DNK DNK

11. Please provide the following information about your current spouse (if applicable):

Full Name (Maiden Name if Wife) Number of Times Date of Birth Age
Please list any aliases Married
DNK DNK DNK DNK
Place of Birth Nationality Current U.S. Date Current Type of Visa
City/Country Immigration Status Immigration Spouse Possesses
Status Will
Expire
DNK DNK DNK DNK DNK
Place Current Visa Issued Date Current Visa Date of Arrival in the U.S. Port of
Expires U.S. Entry
(City/State)
DNK DNK DNK DNK DNK
School(s) Attended Field(s) of Study Degree(s) Earned Date(s) Started Date(s) Ended
DNK DNK DNK DNK DNK

Current or Former Job Title(s) City/Country Where Date(s) Started Date(s) Ended
Employer Name(s) Employed
DNK DNK DNK DNK DNK

Has your spouse ever been arrested, convicted of a crime, or confined in prison -- anywhere? If yes, explain
DNK

12. If your spouse does not currently reside with you, please provide his/her current address:

Street Number and Name


DNK
City State or Province Country Postal Code
DNK DNK DNK DNK

13. Please provide the following information about your former spouse(s), if applicable:

Name of Former Spouse Date of Birth Date & Place of Marriage Date and Place of Divorce
DNK DNK DNK DNK

CHILDREN

14. Please list the following information about your children (if applicable):

Name Sex Place of Birth Date of Current Date Current Type of Visa
(City, Country) Birth Immigration Status Will He/She
Status Expire Possesses
DNK DNK DNK DNK DNK DNK DNK

Has any of your children ever been arrested, convicted of a crime, or confined in prison? If yes, explain
DNK

15. If any of your children does not currently reside with you, please provide his/her current address:

Street Number and Name


DNK
City State or Province Country Postal Code
DNK

DEPENDENT SPONSORSHIP
16. If your spouse or child/children (unmarried and under 21) will need to be sponsored for a dependent visa
status based upon the filing of a petition or application principally on your behalf, or if they will need an
extension of their current dependent visa status, please provide the following:

Dependent’s Name Visa Status Requested or To Be Extended


DNK DNK

PASSPORT INFORMATION

17. Please list the following passport information for you, your wife, and your children:

Passport Holder’s Name Country Issuing Passport Expiration Date


NAVEENKUMAR INDIA 2016

CHOICE OF CONSULATE

18. If you (or a family member) will need to apply for a nonimmigrant “visa” at a U.S. Consulate outside the
United States, please indicate at which consulate you will apply:

City Country
DNK DNK

PARENTS

19. Please list the following information about your parents:

Family Name First Name Date of City/Country of City/Country of


Birth Birth Residence
Father KALAKOTI MALLIKARJUNARAO DNK INDIA ASWARAOPETA
Mother KALAKOTI ANASURYA DNK INDIA ASWARAOPETA

20. Please list the following information about your spouse’s parents:

Family Name First Name Date of City/Country of City/Country of


Birth Birth Residence
Father DNK DNK DNK DNK DNK
Mother

21. Please state if you have any U.S. Citizens or lawful permanent resident (LPR) in your family tree:

Name Relationship U.S. Citizen or LPR?


DNK DNK DNK

EDUCATION
22. Please list the following regarding your education:
School(s) Attended Field(s) of Study Degree(s) Date(s) Date(s)
(Name of School; City/Country) Earned Started Ended
MAHATMAGANDHI JR S.S.C SECOND
1996 1997
COLLEGE(ASWARAOPETA,INDIA)
J.M.V.JR.COLLEGE(YERRAGUNTA,INDIA) INTERMEDIATE SECOND 1997 2000
R.J.C.DEGREE DEGREE(B.S.C CS) FIRST
2000 2003
COLLEGE(KHAMMAM,INDIA)
TRINITY.PG.COLLEGE M.C.A FIRST WITH
DISTINCTIO 2003 2006
N

State any additional qualifications and skills you have:


.NET

List any occupational licenses you hold:


YES

PROFESSION OR OCCUPATION

23. Please provide the following information regarding your current employer or, if you are not currently
employed, for your most recent employer, if applicable:

Employer’s Name Employer’s Address


DNK DNK

Your Job Title Date Started Date Ended Type of Business Hours Worked
Month/Year Month/Year Per Week
DNK DNK DNK DNK DNK
Describe the duties you performed:
DNK

24. Please provide the following information regarding your previous employers over the past 5 years, or for
any jobs you have held that relate to the occupation that you will pursue while in the United States:

Employer’s Name Employer’s Address


DNK DNK
Your Job Title Date Started Date Ended Type of Business Hours Worked
Month/Year Month/Year Per Week
DNK DNK DNK DNK DNK
Describe the duties you performed:
DNK
Employer’s Name Employer’s Address
DNK
Your Job Title Date Started Date Ended Type of Business Hours Worked
Month/Year Month/Year Per Week
DNK
Describe the duties you performed:
DNK

IMMIGRATION AND TRAVEL HISTORY

25. Has an immigrant visa petition to classify you as an immigrant/permanent resident on the basis of your
profession or occupation ever been filed on your behalf? If so, please provide the following:

Name of Petitioner/Employer Date Petition was Filed Result of Filing


DNK DNK DNK

26. If you have ever applied for U.S. Permanent Resident (“green card”) status, please complete the following:

Did you file an I-485 Adjustment of Date You Filed Location Where Result of Filing
Status Application or did you apply Your You Filed Your
for an Immigrant Visa? Application Application
DNK DNK DNK DNK

27. If you (or a family member) have ever applied for a nonimmigrant visa to enter the United States please
provide the following:

Type of Visa Requested Location of U.S. Consulate Date of Visa Result of Visa Application
(specify nonimmigrant visa of Visa Application Application
category)
DNK DNK DNK DNK

28. List the inclusive dates of previous visits to the United States:

Port of Entry Date of Entry Date of Departure Visa Status


DNK DNK DNK DNK
29. If you are OUTSIDE the United States, do you have any plans to travel to the United States in the next 6
months? If so, please provide the following:

Purpose of Visit Entry Date Departure Date Type of Visa to


be Used
DNK DNK DNK DNK

30. If you are INSIDE the United States, do you have any plans to travel abroad before your employer’s petition
on your behalf is filed with the government and/or while your employer’s petition is pending with the U.S.
government? If so, please provide:

Departure Date Return Date Type of Visa to Purpose of Travel


be Used
DNK DNK DNK DNK

MISCELLANEOUS
31. Have you ever:

NO YES If YES, please explain


1. Been treated for a mental disorder, drug NO
addiction of alcoholism?
2. Been arrested, convicted of a crime or confined NO
in prison?
3. Been granted a pardon, amnesty, rehabilitation NO
decree, or other act of clemency?
4. Been a member of or affiliated with a political NO
organization, association, fund, foundation, party,
club, society, or similar group in the U.S. since
your 16th birthday?
5. Been a member of a foreign military service? NO

6. Been refused admission to the U.S. in the last NO


12 months?
7. Registered with a draft board under U.S. NO
Selective Service Law
8. Applied for relief from training and service in NO
the United States armed forces, or departed from
or remained in the U.S. to avoid or evade military
service
9. Falsely claimed to be a U.S. citizen NO
Today’s Date: 18-01-2008 Your Signature:K.NAVEEN KUMAR

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