NextLaw US Entry Waiver Application

U.S. Entry Waiver - New Client Intake Form
This is Stage 1 of our 7-stage process - Your Personal Legal Strategy.

This form helps us understand your specific situation so we can build the strongest possible legal case for you.

After you complete this form, we'll review your answers and send you your personalized document list. This list will show you exactly which documents we need to build your case.
Before you start:
- This form takes 15-30 minutes to complete
- You can save your progress and return anytime
- If you don't remember exact dates, your best estimates are fine - just let us know you're estimating
- Questions? Email us at help@nextlaw.ca
Section 1: Personal Information
Full Legal Name (as shown on official documents)
Last Name (Family Name)
First Name (Given Name)
Middle Name (if any)
Other Names (if applicable)
Have you ever used other names? (maiden names, nicknames, previous married names, names on other documents)
Last Name #1
First Name #1
Middle Name #1 (if any)
Last Name #2
First Name #2
Middle Name #2 (if any)
Birth Information
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year
City / Town
State / Province
Country
Citizenship / Nationality
Gender (select one)

Section 2: Contact Information
Current Mailing Address
Street Number and Name
Apt / Ste / Floor
City or Town
State / Province
Postal Code / Zip Code
Country
I Have Lived Here From

MonthDayYear
2 digit month, 2 digit day, 4 digit year
To

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Phone Numbers
Daytime Phone
Please enter a valid phone number.Format: (000) 000-0000.
Mobile Phone (if different)
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
Email
example@example.com

Section 3: Address History

We need ALL addresses where you have lived in the past 5 years, with no gaps
Previous Addresses
Street Number and Name #2
Apt / Ste / Floor #2
City or Town #2
State / Province #2
Postal Code / Zip Code #2
Country #2
From #2

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
To #2

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Street Number and Name #3
Apt / Ste / Floor #3
City or Town #3
State / Province #3
Postal Code / Zip Code #3
Country #3
From #3

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
To #3

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Street Number and Name #4
Apt / Ste / Floor #4
City or Town #4
State / Province #4
Postal Code / Zip Code #4
Country #4
From #4

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
To #4

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Need to list more addresses? please request addition pages at help@nextlaw.ca

SECTION 4: Marriage Information

If you are currently married, provide the following information about your current spouse.
Current Marital Status
What is your current marital status?
Total number of times married?
Current Spouse's Information
Spouse's Last Name (Family Name)
Spouse's First Name (Given Name)
Spouse's Middle Name (if any)
Spouse's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Spouse's City or Town
Spouse's State or Province
Spouse's Country
Date of Marriage to Current Spouse

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Marriage City or Town
Marriage State or Province
Marriage Country
Previous Marriage Information
Prior Spouse's Legal Name (provide family name before marriage)
Previous Spouse's Last Name (Family Name)
Previous Spouse's First Name (Given Name)
Previous Spouse's Middle Name (if any)
Date of Marriage to Previous Spouse

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Previous Marriage City or Town
Previous Marriage State or Province
Previous Marriage Country
Previous Marriage End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Place Where Marriage with Prior Spouse Legally Ended
End of Marriage City or Town
End of Marriage State or Province
End of Marriage Country
Need to list more previous marriages? please request addition pages at help@nextlaw.ca

Section 5: Employment History
Provide your employment history for the last five years, whether inside or outside the United States. Provide the most recent employment first. This includes:
- full-time jobs
- part-time jobs
- self-employment
- concurrent jobs (if you worked multiple jobs at the same time)
- any other jobs, even if they were for a short time
Current / Most Recent Job
Name of Employer or Company
Your Job Title
Address of Employer or Company
Company Street Number and Name
Company Apt / Ste / Floor
Company City or Town
Company State / Province
Company Postal Code / Zip Code
Company Province
Company Country
Dates of Employment
Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
End Date (leave blank if still working)

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Company #2 Employer or Company Name
Company #2 Job Title
Address of Employer or Company #2
Company #2 Street Number and Name
Company #2 Apt / Ste / Floor
Company #2 City or Town
Company #2 State / Province
Company #2 Postal Code / Zip Code
Company #2 Province
Company #2 Country
Company #2 Dates of Employment
Company #2 Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Company #2 End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year

Section 7: Criminal History
Criminal Convictions
Do you have any criminal convictions?
First Conviction Date
Court Location (City, Province)
Year of conviction
Please explain what happened
Conviction #2 Date
Court Location (City, Province) #2
Year of conviction #2
Please explain what happened with conviction #2
Conviction #3 Date
Court Location (City, Province) #3
Year of conviction #3
Please explain what happened #3
Need to list more conviction dates? please request addition pages at help@nextlaw.ca
Arrests Without Conviction
Have you ever been arrested but NOT convicted?
Arrest #1
City and Province
Year
Please explain what happened
Arrest #2
City and Province of Arrest #2
Year of Arrest #2
Please explain what happened with Arrest #2
Need to list more arrests? please request addition pages at help@nextlaw.ca

Additional Information
Is there anything else we should know about your situation?
By signing below, I confirm that all information provided in this form is complete and accurate to the best of my knowledge.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

U.S. Entry Waiver - New Client Intake Form