留美签证申请表.doc

. Department of State SUPPLEMENTAL NONIMMIGRANT VISA APPLICATION PLEAST TYPE OR PRINT YOUR ANSWERS IN THE SPACE PROVIDED BELOW EACH ITEM PLEASE ATTACH AN ADDITIONAL SHEET IF YOU NEED MORE SPACE TO CONTINUE YOUR ANSWERS 1. Last Name(s) (List all Spellings) 2. First Name(s) (List all Spellings) 3. Full Name (in Native Alphabet) ( 请填中文全名) 4. Clan or Tribe Name (If Applicable) 5. Spouse ’s Full Name (If Married) 5. 配偶全名( 如已婚) 6. Father ’s Full Name 6. 父亲全名 7. Mother ’s Full Name 7. 母亲全名 8. Full N ame and Address of Contact Person anization in the United States (I nclude Telephone Number) 9. List All Countries You have Entered in the Last Ten Years (Give the Year of Each Visit) 10. List All Countries That Have Ever Issued You a Passport 11. Have You Ever Lost a Passport or Had One Stolen? Yes No 12. Not I ncluding Current Employer, List Your Last Two Employers Name Address Telephone No. Job Title Supervisor ’s Name Dates of Employment 12. 列出上两任雇主(除现任雇主外) 公司名称: 公司地址: 电话号码: 工作职务: 主管姓名: 起止日期: Name Address Telephone No. Job Title Supervisor ’s Name Dates of Employment 公司名称: 公司地址: 电话号码: 工作职务: 主管姓名: 起止日期: 13. List all Professional, Social and anizations to Which You Belong (Belonged) or Contribute (Contributed) or with Which You Work (Have Worked) … 14. Do You Have Any Specialized Skills or Training, Including Firearms, Explosives, Nuclear, Biological, or Chemical Experience? Yes No If