1) Do you have a physical or mental disorder; or are you a drug abuser or addict; or do you currently have any of the following diseases: *
- Chancroid
- Gonorrhea
- Granuloma Inguinale
- Leprosy, infectious
- Lymphogranuloma venereum
- Syphilis, infectious
- Active Tuberculosis
2) Have you ever been arrested or convicted for a crime that resulted in serious damage to property, or serious harm to another person or government authority? *
3) Have you ever violated any law related to possessing, using, or distributing illegal drugs? *
4) Do you seek to engage in or have you ever engaged in terrorist activities, espionage, sabotage, or genocide? *
5) Have you ever committed fraud or misrepresented yourself or others to obtain, or assist others to obtain, a visa or entry into the United States? *
6) Are you currently seeking employment in the United States or were you previously employed in the United States without prior permission from the U.S. government? *
7) Have you ever been denied a U.S. visa you applied for with your current or previous passport, or have you ever been refused admission to the United States or withdrawn your application for admission at a U.S. port of entry? *
8) Have you ever stayed in the United States longer than the admission period granted to you by the U.S. government? *