E-3 Employee Questionnaire Instructions: Please provide the necessary information about your company or institution in the spaces provided below. Upon completion, please return this questionnaire to our office at your earliest convenience. The E-3 Visa Petition will not begin until we receive this questionnaire. Thank you very much for your cooperation. Documents Required: Employment Contract or Offer Letter; Copy of your Passport; Copy of your Form I-94 and Visa stamp in your passport; Copy of ALL Form I-20 (both sides) and EAD, only if you are on a F-1 or F-2 status; Copy of ALL previous H-1 Approval Notice, and current pay-stub; Copies of experience letters, resume and state professional license (if applicable); Copies of ALL degrees (both front and back), certificates, diploma(s) and transcripts. Joseph Kallabat & Associates, P.C. 7031 Orchard Lake Road, Suite 302 West Bloomfield, MI 48322 Tel (248) 865-3331 - Fax (248) 865-3323 First Name of Employee Last Name of Employee Name of Employer U.S. Home Address (Number, Street, City, and Town, State ZIP code) Foreign Permanent Address Home Telephone Work Telephone Email Address Date of Birth Country of Birth Province of Birth Country of Citizenship Passport Number Passport Issue Date Passport Expiration Date Current Visa Status Date Current Visa Expires I-94# Latest Date of Arrival in the U.S. Social Security Number Consulate closest to foreign address Have you ever filed a U.S. Immigrant Visa petition? yesno Has any person in this petition ever been denied any visa classification to come to the United States? yesno SPOUSE AND DEPENDANT DOCUMENTS AND INFORMATION Spouse First Name Spouse Middle Name Spouse Last Name If you are applying for an H-4 (Dependent Visa), please provide a copy of the following documents: Spouse or Dependent's Form I-94; Visa stamps within the passports; Spouse’s Marriage Certificate and Child’s Birth Certificate. INFORMATION REQUIRED: SPOUSE: Date of Birth Country of Birth Date of Arrival Passport Expiration Spouse's I-94# Issue Date of I-94 Visa Status Visa Expiration CHILDREN/DEPENDANTS: Date of Birth Country of Birth Date of Arrival Passport Expiration Children/Dependents I-94# Issue Date of I-94 Visa Status Visa Expiration CHILDREN/DEPENDANTS #2: Date of Birth Country of Birth Date of Arrival Passport Expiration Children/Dependents I-94# Issue Date of I-94 Visa Status Visa Expiration Terms of Engagement – Representation Joseph Kallabat & Associates, PC (hereafter “JK&A”) will solely represent your Employer in connection with the requested E-3 Visa Petition services (the Services). Please review the below information and by submitting the questionnaire you have no objections to JK&A’s representation of your Employer in connection with the Services. The I-129 nonimmigrant petition is an Employer sponsored petition. You desire that JK&A provide the Services in a manner most likely to result in the expeditious issuance of the E-3 visa on your behalf. Please note JK&A’s obligation to represent and respect the wishes of your Employer is our primary responsibility. JK&A does have a duty to your Employer and any information that is material to the representation of either party will be disclosed accordingly. There are several issues which you must be aware of concerning JK&A’s representation of your Employer. The first concerns our obligation of confidentiality. Attorneys are under a duty not to disclose to anyone any information disclosed by a client to the attorney in confidence. JK&A will not disclose any information that you provide to us in connection with the Services to any third party. However, JK&A’s representation will obligate us to disclose your information that is material information relating to the representation to your Employer without regard to whether such information constitutes a client confidence or secret. Second, at issue in any representation setting is the Attorney’s ability to represent its client with zeal and loyalty, should a conflict arise. There always exist potential areas of conflict in representation situations. Should an actual conflict between you and your Employer arise, JK&A will inform both parties of the feasibility of JK&A’s continued representation. Should JK&A find our continued representation is in both parties interest, we will, after full disclosure, continue your representation. JK&A’s main consideration will be whether we can, in fact, zealously represent both parties without compromising our loyalties to either. Yet, should a dispute be such that the parties decide to litigate, by agreeing to the terms listed here, you allow JK&A to choose to continue representation of your Employer without your prior consent should we so choose. Any information we have obtained during this representation, whether confidential or not, can be disclosed by us. By submitting the E-3 questionnaire you acknowledge that you understand the potential advantages and disadvantages of this representation, and that you have decided to proceed with this representation. You hereby waive your right to disqualify JK&A from representing your Employer in other immigration matters. I have read and agree to the Terms of Engagement - Representation What is the result of below calculation?
