CONTACT INFORMATION: Please provide the following contact information:

First Name
Middle Name
Last Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Home Phone
Cell Phone
Work Phone
E-mail

Business Employer Identification Number (EIN)

REFERRAL SOURCE: How were you referred to Glinsmann Immigration Lawyers? (choose one)

Client of the Firm Attorney/Accountant Google Avvo Lawyers.Com/Martindale Yahoo Cornell Law AILA Other

TYPE OF ENTITY:

C Corporation
S Corporation
LLC Limited Liability Company
Partnership
Sole Ownership
Other

DATE BUSINESS STARTED: Enter the year your business was STARTED OR ACQUIRED:

STATE: In what State is your business formed?

DESCRIPTION OF YOUR BUSINESS:

EMPLOYEES: Number of Full or Part Time Employees:

Number of Independent Contractors employed:

EMPLOYEE NAME: Enter the name of the CANDIDATE OR EMPLOYEE you would like to sponsor in the space provided below:

JOB TITLE: Identify the offered position:

EDUCATION: Education Required for the Job (choose one of the following options):

High School Diploma Associates Degree Bachelor of Arts/Science Masters Doctoral/Professional Degree No Minimum Education

EXPERIENCE: Enter your NUMBER OF YEARS OF EXPERIENCE required to perform the offered position in the space provided below:

JOB DUTIES OF THE OFFERED POSITION:

QUESTIONS: List any questions you would like answered during the initial consultation: