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OnlineNonimmigrantVisaApplication(DS-Application-SensitiveButWedonotneedaprintedcopyofyourapplicationatanypointduringyourinterviewprocess.Onlyprintthisapplicationifyouwantacopyforyourownrecords.Ifyouprintyourapplication,pleasekeepitsecure.PhotoConfirmation alCopy--DoNotBringtoal,Address,Phone,and Name DONG,FullNameinNative OtherNames ecodeName 5516,2651 Dateof 14FEBRUARYceof Doyouholdorhaveyouheldanynationalityotherthantheone indicatedaboveonnationality?U.S.SocialSecurity DOESNOTU.S.TaxpayerID DOESNOTHome NO.26MINZIQIAN PostalZone/ZIP SameMailing PrimaryPhoneSecondaryPhoneWorkPhone DOESNOT PassportBookCountry/AuthoritythatIssued CityWhere State/ProvinceWhere Country/RegionWhereIssuance 15DECEMBERExpiration 14DECEMBERHaveyoueverlostapassportorhadone TravelTheListofPurposesofTriptotheU.S.PurposeofTriptotheU.S. TEMP.BUSINESSPLEASUREVISITOR TOURISM/MEDICALTREATMENTHaveyoumadespecifictravel IntendedDateof 01MARCHIntendedLengthofStayin 3Addresswhereyouwillstayinthe 160WESTBIGSPRINGS/EntityPayingforYour Arethere stravelingwith Areyoutravelingaspartofagroupororganization? sTravelingwithYou:Name DU,Relationshipto Haveyoueverbeeninthe HaveyoueverbeenissuedaU.S. HaveyoueverbeenrefusedaU.S.Visa,orbeenrefusedadmissionto theUnitedStates,orwithdrawnyourapplicationforadmissionattheportofHasanyoneeverfiledanimmigrantpetitiononyourbehalfwiththe UnitedStatesCitizenshipandImmigrationServices?U.S.Contact Nameinthe DONG,OrganizationNameinthe DONOTRelationshipto U.S.Contact 160WESTBIGSPRINGSRIVERSIDE,CALIFORNIAPhoneFamilyFather's Father'sDateof DONOTIsyourfatherinthe Mother's Mother'sGiven Mother'sDateof DONOTIsyourmotherinthe Doyouhaveanyimmediaterelatives,notincludingparentsinthe DoyouhaveanyotherrelativesintheUnited Spouse'sFull DU,Spouse'sDateof 09MARCHSpouse'sCityof Spouse’s SAMEASHOMEWork/Education/TrainingPrimary Wereyoupreviouslyemployed? EmployerName Employer CHEZHAN PostalZone/Zip ephone Job Supervisor's Supervisor'sGiven EmploymentDate 05DECEMBEREmploymentDate 13DECEMBERBrieflydescribeyourduties: Haveyouattendedanyeducationalinstitutionsatasecondarylevelor Doyoubelongtoaclanor ProvideaListofLanguagesYouSpeak:LanguageName:(1):Haveyoutraveledtoanycountrieswithinthelastfive Haveyoubelongedto,contributedto,orworkedforanyprofessional, social,orcharitableorganization?Doyouhaveanyspecializedskillsortraining,includingfirearms, explosives,nuclear,biological,orchemicalexperience?Haveyoueverservedinthe Haveyoueverservedin,beenamemberof,orbeeninvolvedwitha paramilitaryunit,vigilanteunit,rebelgroup,guerrillagroup,orinsurgentDoyouhaveacommunicablediseaseofpublichealthsignificance?(Communicablediseasesofpublicsignificance includechancroid,gonorrhea,granulomainguinale,infectiousleprosy,lymphogranulomavenereum,infectiousstagesyphilis,activetuberculosis,andothersdiseasesasdeterminedbytheDepartmentofHealthandHumanDoyouhaveamentalorphysicaldisorderthatposesorislikelytoposeathreattothesafetyorwelfareofyourself orothers?Areyouorhaveyoueverbeenadrugabuseror Haveyoueverbeenarrestedorconvictedforanyoffenseorcrime,eventhoughsubjectofapardon,amnesty,or othersimilaraction?Haveyoueverviolated,orengagedinaconspiracytoviolate,anylawrelatingtocontrolled AreyoucomingtotheUnitedStatestoengageinprostitutionorunlawfulcommercializedviceorhaveyoubeen engagedinprostitutionorprocuringprostituteswithinthepast10years?Haveyoueverbeeninvolvedin,ordoyouseektoengagein,money HaveyouevercommittedorconspiredtocommitahumantraffickingoffenseintheUnitedStatesoroutsidethe UnitedStates?Areyouthespouse,son,ordaughterofanindividualwhohascommittedorconspiredtocommitahumantrafficking offenseintheUnitedStatesoroutsidetheUnitedStatesandhaveyouwithinthelastfiveyears,knowinglybenefitedfromthetraffickingHaveyouknowinglyaided,abetted,assistedorcolludedwithanindividualwhohascommittedorconspiredtocommit aseverehumantraffickingoffenseintheUnitedStatesoroutsidetheUnitedStates?Doyouseektoengageinespionage,sabotage,exportcontrolviolations,oranyotherillegalactivitywhileinthe UnitedStates?DoyouseektoengageinterroristactivitieswhileintheUnitedStatesorhaveyoueverengagedinterrorist Haveyoueverordoyouintendtoprovidefinancialassistanceorothersupporttoterroristsorterroristorganizations? Areyouamemberorrepresentativeofaterrorist Haveyoueverordered,incited,committed,assisted,orotherwiseparticipatedin Haveyouevercommitted,ordered,incited,assisted,orotherwiseparticipatedin Haveyoucommitted,ordered,incited,assisted,orotherwiseparticipatedinextrajudicialkillings,politicalkillings,or otheractsof Haveyoueverengagedintherecruitmentortheuseofthechild Haveyou,whileservingasa ernmentofficial,beenresponsibleforordirectlycarriedout,atanytime,particularly severeviolationsofreligious Haveyoueverbeendirectlyinvolvedintheestablishmentoren mentofthepopulationcontrolsforcingawoman toundergoanabortionagainsther choiceoramanorawomantoundergosterilizationagainsthisorherHaveyoueverbeendirectlyinvolvedinthecoercivetransntationofhumanorgansorbodily Haveyoueversoughttoobtainorassistotherstoobtainavisa,entryintotheUnitedStates,oranyotherUnited Statesimmigrationbenefitbyfraudorwillfulmisrepresentationorotherunlawfulmeans?HaveyoueverwithheldcustodyofaU.S.citizenchildoutsidetheUnitedStatesfroma grantedlegalcustody
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