American Clients Background Check
(Example)
<For Khersongirls clients these question will be on your My Account section under Questionaire>

For Questions about this new law see the explanation at http://imbra.org/pages/1/index.htm or
http://usaimmigrationattorney.com/nucleus/index.php?itemid=2

This form is used to meet the requirement of HR03657. This information will be translated into Russian and provide to any lady that you wish to make contact with either via purchase of her contact information. Provide her with your contact information or a meeting in person.
(Note: Letters, gifts and chats that do not include exchange or contact information does not require this form.)

The office will charge you a one time fee of $15.00 to complete the requirement of this form and translate it into Russia/Ukranian

Please provide the following contact information (This will be pulled from the client records or manually entered):

First Name

Last Name

Middle Initial

Items Yellow are not required by the new law but added to help our ladies remember the men.

Date of Birth

Sex Male

Height

Weight

Hair Color

Eye Color1

Photo of Men

(1) Do you have any temporary or permanent civil protection order or restraining order issued against you?

Yes No

If Yes, Please provide details of such order including date, city and state.

(2) Any arrest or conviction of the client or person for homicide, murder, manslaughter, assault, battery, domestic violence, rape, sexual assault, abusive sexual contact, sexual exploitation, incest, child abuse or neglect, torture, trafficking, peonage, holding hostage, involuntary servitude, slave trade, kidnapping, abduction, unlawful criminal restraint, false imprisonment, stalking, or any similar activity in violation of Federal, State or local criminal law?

Yes No

* If Yes so please provide details.

(4) Have you ever had any Federal, State, or local arrest or conviction for offenses related to controlled substances or alcohol?

Yes No

* If Yes so please provide details

(5) Are you currently married or were you ever married?

Yes No

* If Yes pleases indicate how many times you have been married, when and where you were previously married, when and where previous marriage's) were dissolved?

(6) Have you previously sponsored an alien to whom you were engaged or married?

Yes No

* If Yes please provide details.

(7) Do you have any children who are under the age of 18?

Yes No

* If yes please list how many First Names and ages of Children.

(8) List all States and countries in which you have resided since the age of 18?

Admin Section: (This is where we will post our verification.)

Internet Search for Sex offender completed? http://www.nsopr.gov/

Yes No

What's states were checked and Results?

American Clients Background Check (Example) <For Khersongirls clients these question will be on your My Account section under Questionaire>

American Clients Background Check
(Example)
<For Khersongirls clients these question will be on your My Account section under Questionaire>