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FBI Questionnaire Form

Advisory

The US Department of Commerce requires the following FBI Questionnaire to be submitted as support documentation for the US deemed export license application for foreign nationals.

Note: All fields marked asterisk(*) are mandatory.
* Please enter date in mm-dd-yyyy format.

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1.   Employee's name:*
First Name Last Name
2.   Date of birth:*    Pick a date
3.   Place of birth:*
4.   Passport number:*
5.   Country passport issued from:*
6.   I-94 number:*
7.   Date I-94 was issued:*    Pick a date
8.   Place I-94 was issued:*
9.   Expiration of I-94:*    Pick a date
10.  Visa type:*
11.  Date visa was issued:*    Pick a date
12.  Place visa was issued:*
13.  Visa expiration date:*    Pick a date
14.  Last address in country of citizenship:
     Address1:*
     Address2:
     City:*
     State:*
     Country:*
     Zip Code:*
15.  Current address in U.S.:
     Address1:*
     Address2:
     City:*
     State:*
     Country:*
     Zip Code:*
16.  Job description:*
17.  Type of degree (U.S.-based):
18.  Date degree was received:   Pick a date
19.  School name and address:
     Name:
     Address1:
     Address2:
     City:
     State:
     Country:
     Zip Code:
20.  Type of degree (non-U.S.-based):
21.  Date non-US based degree was received :   Pick a date
22.  School name and address(non-U.S.-based):
     Name:
     Address1:
     Address2:
     City:
     State:
     Country:
     Zip Code:
23.  Family in your home country:* Yes No
24.  Financial ties in your home country:* Yes No
25.  Financial ties in U.S.:* Yes No
26.  Children's names (write "N/A" if not applicable):
27.  Citizenship of spouse
28.  Submitter e-mail Address:*