U.S. Immigration Assessment Form

Dear Sir/Madam:

Please complete the assessment form and click the "Submit" button at the bottom of the page when finished. If you are married or engaged, you will be directed to complete an assessment form for your spouse or fiancée. If you are a business owner, you will be directed to complete a business form. 

We will review your information and contact you with the results of our assessment.
Thank you.

Worldwide Relocation Services Inc.

 I wish to apply for U.S. immigration in category because:  


Assessment Form * = Required fields     
  Personal Information
* Full Name (First Middle Last)  

* Date of Birth (Month Day Year)



   Place of Birth
* Email Address
   Contact Person (Name  & Address)
* Contact Telephone
   Home Telephone

   Daytime Telephone

   Fax (Home)

   Fax (Work)

* Current Mailing Address:  

 Marital Information
* Marital Status
   Date of Marriage (Month Day Year) (Year)
   Name of Spouse (First Middle Last)

 Dependents Information
Provide details of all your children. If you do not have any children please continue on to next step.



Date of  Birth




 Relatives Information
Details of your relatives in U.S. (Describe the relationship clearly, such as father's real brother, mother's real sister, etc.)
Name Relationship Address Profession

 Education Information
Please provide your educational record with dates, name and address of institutions attended, courses taken, and degree/diploma/certificate received.  Include all full time and part time courses.


Name & Address of Institution



       Month   Year     Month   Year
From:/  To:/

From:/  To:/

From:/  To:/

From:/  To:/

 Employment Information
Please provide your employment record(s) with dates, name & address of employers, job titles and duties performed.
Period Name & Address of Employers Job Title & Job Duties
       Month   Year     Month   Year
From:/  To:/

From:/  To:/

From:/  To:/

From:/  To:/

 Extraordinary Talent
Do you and your spouse have any extraordinary ability in art, sports, science and/or business, if so, do you ever gain national or international awards? Please explain in detail.

Please provide the detailed job duties you have performed in each of your employment and any outstanding award or national recognition.
You may simply copy and paste your resume in the box below. (This will assist in defining a suitable category)

 Language Skills
Please indicate your ability to communicate in English and Spanish.
English   Spanish
  High Moderate Basic None   High Moderate Basic None

Business Information
Important: If you have ever owned or operated your own business, check here and you will be prompted to complete a business profile after submitting this form.
Your current net worth (assets less liabilities). Include all bank deposits, property, and other assets.
Your current monthly income

 Residence / Visa Status
List all countries you have visited.
Your current status in the country you are living in.
Your current visa in your resident country is/was valid until.
For which countries do you have valid visitor visas?

 Background Information
Are you aware of any Medical or Criminal problem for yourself or your family?
If yes, please give details:
Have you ever been refused tourist or other visas?
If yes, please give details:
Have you ever been deported from any country?
If yes, please give details:

How did you come to know about WRSI?  

By clicking "Submit" I declare that the information given in this application is truthful, complete and correct.