WATCH YOUR STEP AND FOLLOW THE GUIDE

I hereby apply to the Secretary of Homeland Security for permission to enter the United States temporarily under the provisions of section 212(d)(3)(A)(ii) of the Immigration and Nationality Act (INA).

1. Full name:

2. Date of birth (mm/dd/yyyy)

George Andrew Piquette

01/28/1967

3. Place of birth,(Town, State/Province, Country)

4. Citizenship/Nationality

Ottawa/Ontario/Canada

Canadian

5. Present Address, Telephone Number, and Email Address

593, Newton, Sherbrooke, Qc, (819) 555-1212, gpiquette@hotmail.com

6. All addresses at which I have resided during the past five years (Use a separate sheet of paper if necessary.)

HERE YOU WILL LIST ALL FIVE YEARS

At the above address since July of 2009
At 3232, Venice Blvd in Oromocto New-Brunswick from July of 2003

7. Desired Port of Entry into the United States

8.Means of Transportation

CHOSE a Border Crossing or Airport

Car, Plane, etc...

9. Proposed Date of Entry

10.Approximate Lenght of Stay in the United States

As allowed

Determined at entry

11. My purpose for entering the United States is: (Explain fully)

HERE YOU WILL LIST ANY LEGITIMATE REASON SUCH AS:

Tourism, shopping, visiting friends, visiting family, investing, attend trade shows etc....
IF your job requires you to go to the US, have your employer confirm the necessity and the frequency of your trips!

OR IF YOU FEEL CREATIVE

You will write: Please refer to my Statement of Purpose
AND
Include a separate letter that you will title: STATEMENT OF PURPOSE.

12. I believe that I may be inadmissible to the United States for the following reason(s) and no others:

Past criminal conviction(s). Please see the enclosed Letter of Circumstances.

13. I        have        have not previously filed an application for advanced permission to enter as a nonimmigrant

  on

, at                    

EITHER you have OR you haven't. If you have, tell them when and where.
THEY ALREADY KNOW ANYWAY!

If you are an applicant for T and U nonimmigrant status, you do not need to answer questions 14 through 17.

14. Have you ever been in the United States for a period of six months or more? If yes, when, for how long and in what immigration status?

Give the details as best you can remember, BE PRECISE.
If you are uncertain of dates and details, explain this HERE.

You ABSOLUTELY want to avoid giving the impression that you are trying to mislead them!

15. Have you ever filed an application or petition for immigration benefits with the U.S. Government, or has one ever been filed on your behalf? If yes, list the application and/or petition, the filing locations and describe the outcome of each application/petition (for example: denied, approved, pending).

ONCE AGAIN, they have a computer! Don't try to hide anything. If you are unsure of dates and/or circumstances, make it clear that you are not misleading them.

16. Have you ever been denied or denied an immigration benefit by the U.S. Government, or had a benefit revoked or terminated (including but not limited to visas)? Describe in detail.

JUST TELL THE TRUTH!

17. Have you ever, in our out of the United States, been arrested, cited, charged, indicted, fined or imprisoned for breaking or violating any law or ordinance, excluding minor traffic violations? Describe in detail. Include all offenses where impaired driving may have been an issue.

See attached court documents and Letter of Circumstances

NOTA BENE
The C-480 form (the proof of your criminal record that you get back from the R.C.M.P.) will only show convictions. If an incident is not listed, this is the place to give details about it.
Don't forget to mention foreign arrests or acquittals.

SOMETHING LIKE THIS
1998 arrest for shoplifting does not qualify as a detailed explanation.

PREFERRED VERSION
In 1998, at a Walmart, I stole a $59 dollars drill. As I was leaving the store, a security guard intercepted me. The drill was retrieved and I was told never to go there again. There was no prosecution.

OR

In 1996, I was suspected of larceny and I was arrested at my workplace. Due to lack of evidence, I never went to trial.

18. Applicant's Signature and Certification
I understand that the information herein contained may be used in any proceedings (including civil, criminal, immigration, or any other judicial proceeding) hereafter instituted against me.
I certify that the statements above and all attachments hereto are true and correct to the best of my knowledge and belief.




            (Signature of Applicant)

(Date)            


Signature of the applicant/Signature of Guardian or Family Member (if Applicant is unable to sign)



19. Preparer's Signature and Certification
I declare that this document was prepared by me at the request of the applicant or qualified relative/legal guardian of the applicant, and is based on all information of which I have knowledge and/or was provided to me by the above named person in response to the exact questions contained on this form. I have not knowingly witheld any information.


(Signature If someone else prepared this application, have then sign and date it.