Tarkoic Law Intake Forms

First Name Middle Name Last Name

Date Of Birth M D Y

A# (If any) A #

Have You Ever Used Another Name?

Yes

No

I don't know

Address Street Address

City, State & Zip

Home Phone Cell Phone Work Phone

Email Address Email Address If hired, a valid email address that is checked regularly is required.

Country of Birth

How old were you when you first came to America?

Please write down EVERY ENTRANCE/EXIT to the United States and your Immigration Status at the time. If you ever entered and were sent back the same day, list those entries/exits too. IF you are uncertain of the exact date, please enter your best guess. If you have never entered the United States, check the box below and leave the rest blank.

I have never entered the United States.

Date Entered Where did you Enter? Date Left Status

Have you EVER been arrested deported, detained or released by any Immigration Judge or Officer?

Yes

No

(If Yes, Explain the date, place, and outcome.)

Are you married, engaged, or living with a Partner?

Yes

No

What is your spouse/fiancée/partner’s full name?

What is his/her immigration status?

Have you divorced or been widowed in the past?

Yes

No

1. Prior spouse’s name:

2. Prior spouse’s name:

Do you have any children or step children?

Yes

No

Are they U.S. Citizens or Legal Permanent Residents?

Yes

No

Do you have parents or siblings that are U.S. Citizens or Permanent Residents?

Yes

No

Are you currently employed?

Yes

No

Where are you employed (Name of Employer)?

Are you filing taxes with the IRS?

Yes

No

What is your highest level of education?

Have you ever been charged/arrested for any crime? (This includes driving tickets or even if the charge was dismissed or expunged.)*Your answers are confidential so please tell us the truth*

Yes

No

Please List charges and the city and state where occurred. Charge City & State

Have you, your spouse, or kids, been victims of a crime? (There are visas for victims.)

Yes

No

Have you ever had to call the police, DSS, or other agency to report a crime?

Yes

No

Have you ever lied to Immigration before for any reason?

Yes

No

How did you hear about our office?

Please include any other information you would like to provide.

Intake Form - English