US Visa Application Information
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
TRN Number
Phone Number
Please enter a valid phone number.
If you have any other numbers or have had in the last 5 years, please provide below:
Email address
Have you used any other email within the last 5 years? If yes, please provide below:
Address
*
Street Address
Street Address Line 2
City
Parish
Postal / Zip Code
Mother's Full Name
First Name
Last Name
Mother's Date of Birth
-
Month
-
Day
Year
Date
Is your mother in the U.S.
Yes
No
Father's Full Name
First Name
Last Name
Father's Date of Birth
-
Month
-
Day
Year
Date
Is your father in the US?
Yes
No
Relationship Status
Single
Commonlaw
Married
Widowed
Divorced
If not single, please provide partner's Name, DOB and Place of birth
Full name, Address, Phone number and Email address of the person/organization you will be staying with:
Relationship to US Contact:
Please Select
Sibling
Parent
Uncle
Aunt
GrandParent
Friend
In Law
Cousin
Child
Spouse
Exact intended date of Arrival
-
Month
-
Day
Year
Date
How long will you stay? (ex. 3 days,2 weeks. 1 month)
Social Media Accounts/Names
Who is paying for the trip and is anyone traveling with you (provide name and relationship?)
Have you ever been REFUSED a visa?,
YES
NO
Have you ever been in the USA ?, if YES please provide last 5 entry dates and how long you stayed each visit?:
Have you been ten-printed? (yes/no)
Do you have a Social Security Number?/ Have you ever been on filling?
If you have immediate family (Parents, Brother, Sister, Children) members in the US, Please provide full name, status(citizen, green card holder) and relationship to you
Please provide your Current and Previous Jobs (Name of Business, Address, Job Title, Start Date/End Date and Income in JMD Currency)
Educational Background, Please provide Name, Address, Studies and Start and End Date (Current and Previous)
Have you travelled to any countries/ regions within the last 5 years?
Please Select
Yes
No
Do you have a communicable disease of public health significance? (Communicable diseases of public significance include chancroid, gonorrhea, granuloma inguinale, infectious leprosy, lymphogranuloma venereum, infectious stage syphilis, active tuberculosis, and other diseases as determined by the Department of Health and Human Services.)
Yes
No
Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare of yourself or others?
Yes
No
Are you or have you ever been a drug abuser or addict?
Yes
No
Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty, or other similar action?
Yes
No
Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances?
Yes
No
Please upload a clear picture of your PASSPORT and any Expired/Current Visa: (For your passport size picture, ask the photo place to email a copy to you so it can be forwarded to us. If the photo is scanned the visa application photo check will not accept your photo.)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: