Fast Card Canada Application
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Immigroup Inc. 1180 Danforth Ave, Toronto, ON M4J 1M3 Phone: 1-866-760-2623 Fax: 416-640-2650 Email: [email protected]
FAST CARD
IMMIGROUP ORDER FORM INSTRUCTIONS
Read all instructions and follow carefully 1. Please complete one (1) FAST CARD application form per person. Complete the address and employment fields for the last five (5) years in full, leaving NO gaps (including when unemployed or as a student). If you require additional space, please use the 'Required Supplementary Information' forms provided. 2. Make clear copies of your valid citizenship and identity documents (i.e. passport, birth certificate, PR card, work/study permit, etc.). If applicable, make copies of your drivers license and vehicle registration. 3. Complete this order form in full, ensuring you have included all requirements on the 'FAST CARD Package Checklist'. 4. Send your entire completed package using one of the following methods: FAX application package to 416-640-2650 OR SCAN AND EMAIL your entire application package to [email protected] with the subject line: (Name of Applicant) FAST CARD Application OR MAIL/DROP OFF your entire application package to our head office at: 1180 DANFORTH AVE, TORONTO, ON CANADA M4J 1M3
FAST CARD PACKAGE CHECKLIST
Include the following documents in your FAST CARD package FAST CARD APPLICATION FORM completed and signed (all forms must be included, even if blank) IMMIGROUP ORDER FORM - applications submitted without this form will not be processed COPY OF VALID CITIZENSHIP DOCUMENT -i.e. passport, citizenship card, birth certificate, etc. COPY OF VALID ADMISSIBILITY DOCUMENT -i.e. passport, PR card, work/study permit, etc. COPY OF VALID DRIVERS LICENSE -you must have a drivers license for this application COPY OF VEHICLE REGISTRATION -if applicable APPLICATIONS SUBMITTED WITHOUT THIS ORDER FORM WILL NOT BE PROCESSED
ADDITIONAL INFORMATION
* Initial review of your application entails background checks in both Canada and the US * Once you have been conditionally approved, we will contact you to schedule an interview; you must schedule this interview within 30 days of approval * Once you attend your interview and have been approved, your card will be mailed to you at the address you provide * Sending incomplete applications will delay processing
SERVICE OPTIONS
BASIC SERVICE PREMIUM SERVICE
$219.50 $150 service fees
$19.50 HST (harmonized sales tax) $50 CDN government fees*
$332.50 $250 service fees
$32.50 HST (harmonized sales tax) $50 CDN government fees*
AVERAGE PROCESSING TIME** 6-8 WEEKS
*after applicable exchange rates **Timeline refers to initial review by the government
AVERAGE PROCESSING TIME** 2-4 WEEKS
*after applicable exchange rates **Timeline refers to initial review by the government. If initial review is not complete within 3 weeks, you will be refunded $113
By signing below I agree to be charged the applicable service fees to the credit card I have provided.
We accept Visa, Mastercard, Amex, and brank drafts (call for this method) as acceptable methods of payment
CREDIT CARD INFORMATION
DISCLAIMER
By signing below applicant agrees to all of the following conditions
*I assert that I have read and agreed to the terms and conditions as listed on http://www.immigroup.com/disclaimer.php *Immigroup is not responsible for applications lost in the mail or improperly submitted by email or fax *Immigroup is not responsible for applications that are denied *Immigroup is not responsible for delays caused by incomplete applications *Basic service fees are non-refundable once applications are submitted to the government *A portion of 'Premium Service' fees are refunded only if initial processing exceeds 3 weeks from the date your credit card was charged * Government fees are non-refundable in all cases *I assert that I understand I am using Immigroup to apply for my NEXUS card *I agree to being charged the total fees according to the service I have selected to the credit card provided.
Cardholder name: Card number: Expiry date (mm/yy): Cardholder signature: CVV code:
What is the CVV code? www.sti.nasa.gov/cvv
SIGN HERE:
Immigroup Inc. 1180 Danforth Ave, Toronto, ON M4J 1M3 Phone: 1-866-760-2623 Fax: 416-640-2650 Email: [email protected]
FAST CARD COMMERCIAL DRIVER APPLICATION
FIRST TIME APPLICANT RENEWAL/REAPPLICATION PLEASE PROVIDE PREVIOUS FAST ID # IF YOU HAVE APPLIED THROUGH GOES BEFORE PLEASE GIVE USER ID AND PASSWORD
PERSONAL DATA
LAST NAME OTHER NAMES USED DATE OF BIRTH PREFERRED INTERVIEW LOCATION DRIVERS LICENCE NUMBER FIRST NAME OTHER NAMES USED COUNTRY OF BIRTH EMAIL ADDRESS DRIVERS LICENCE EXPIREY DATE MIDDLE NAME IF USED GENDER TOWN AND PROVINCE/STATE HOME TELEPHONE CELL PHONE
ISSUING PROVINCE / STATE
IS THIS AN ENHANCED DRIVERS LICENCE?
IS THIS A COMMERCIAL DRIVER LICENCE?
DO YOU HAVE CLEARANCE FOR HAZARDOUS MATERIALS (HAMZAT)?
CITIZENSHIP DATA
SPECIFY IF OTHER CANADIAN PASSPORT # PASSPORT # USA EXPIRY DATE EXPIRY DATE ISSUING COUNTRY ISSUING COUNTRY
ONLY COMPLETE THIS SECTION IF YOU DO NOT HAVE A CANADIAN OR US PASSPORT
PR CARD # BIRTH CERTIFICATE # CITIZENSHIP CARD#
5 YEAR ADDRESS HISTORY
CURRENT ADDRESS FROM (YEAR/MONTH) CITY # STREET APT #
POST / ZIP CODE
PROVINCE / STATE +COUNTRY
MAILING ADDRESS IF DIFFERENT TO YOUR CURRENT ADDRESS
PREVIOUS ADDRESS FROM (YEAR/MONTH) CITY TO (YEAR/MONTH) # STREET
POST / ZIP CODE
PROVINCE / STATE +COUNTRY
PREVIOUS ADDRESS FROM (YEAR/MONTH) CITY
TO (YEAR/MONTH)
#
STREET
POST / ZIP CODE
PROVINCE / STATE +COUNTRY
PREVIOUS ADDRESS FROM (YEAR/MONTH) CITY
TO (YEAR/MONTH)
#
STREET
POST / ZIP CODE
PROVINCE / STATE +COUNTRY
PREVIOUS ADDRESS FROM (YEAR/MONTH) CITY
TO (YEAR/MONTH)
#
STREET
POST / ZIP CODE
PROVINCE / STATE +COUNTRY
PREVIOUS ADDRESS FROM (YEAR/MONTH) CITY
TO (YEAR/MONTH)
#
STREET
POST / ZIP CODE
PROVINCE / STATE +COUNTRY
5 YEAR EMPLOYMENT AND UNEMPLOYMENT HISTORY
MINORS UNDER 18 NEED NOT COMPLETE THIS SECTION. IF YOU ARE RETIRED, A STUDENT OR UNEMPLOYED WE NEED TO KNOW THE FROM AND TO DATE: NO OTHER DETAILS ARE REQUIRED.
CURRENT EMPLOYMENT FROM (YEAR/MONTH) EMPLOYER’S ADDRESS OCCUPATION EMPLOYER’S NAME
POST / ZIP CODE
CITY + PROVINCE / STATE
EMPLOYER’S PHONE NUMBER PREVIOUS EMPLOYMENT FROM (YEAR/MONTH) EMPLOYER’S NAME POST / ZIP CODE PREVIOUS EMPLOYMENT FROM (YEAR/MONTH) EMPLOYER’S NAME TO (YEAR/MONTH) TO (YEAR/MONTH) OCCUPATION
EMPLOYER’S ADDRESS CITY + PROVINCE / STATE OCCUPATION EMPLOYER’S PHONE NUMBER
EMPLOYER’S ADDRESS
POST / ZIP CODE
CITY + PROVINCE / STATE
EMPLOYER’S PHONE NUMBER
PREVIOUS EMPLOYMENT FROM (YEAR/MONTH)
TO (YEAR/MONTH)
OCCUPATION
EMPLOYER’S NAME
EMPLOYER’S ADDRESS
POST / ZIP CODE
CITY + PROVINCE / STATE
EMPLOYER’S PHONE NUMBER
PREVIOUS EMPLOYMENT FROM (YEAR/MONTH)
TO (YEAR/MONTH)
OCCUPATION
EMPLOYER’S NAME
EMPLOYER’S ADDRESS
POST / ZIP CODE
CITY + PROVINCE / STATE
EMPLOYER’S PHONE NUMBER
ADDITIONAL INFORMATION
Have you ever been convicted of an offense in any country for which you have not received a pardon?
NO YES
Have you ever received a waiver of inadmissibility to the U.S. from a U.S. government agency?
NO YES
Have you ever been approved by Citizenship and Immigration Canada for rehabilitation because of past criminal activity?
NO YES
Have you ever been found in violation of customs or immigration laws or other federal import laws?
NO YES
IF YOU HAVE ANSWERED YES TO ANY QUESTION, PLEASE GIVE DETAILS:
CERTIFICATION
I certify that all information given on this application and in support of this application was provided voluntarily and is true and complete. I understand that any information on this application, including any supporting documentation, background information and biometric data will be shared among Customs and Immigration authorities in both Canada and the U.S. and among law enforcement and other government agencies in accordance with applicable laws. I certify that I have read, understood and agree to abide by all conditions required for use of the FAST program, including all instructions and notices accompanying this application.
Print name
Date
Signature
FEE PAYMENT
Immigroup Fee: CAD $157.50 (includes 5% GST)
Government Fee: CAD/USD $50 I enclose a certified cheque or money order VISA
AMEX
MASTERCARD
CREDIT CARD NUMBER
CVV CODE
EXPIRY DATE
CARD HOLDER’S NAME
PLEASE ATTACH READABLE COPIES OF SUPPORTING DOCUMENTS FOR VERIFICATION
SUPPLEMENTAL ADDRESS HISTORY ** PLEASE LIST YOUR ADDRESS HISTORY FOR THE PAST FIVE (5) YEARS. LEAVE NO GAPS** DATE FROM: ______/________ DATE TO: ______/______
Street Number _____ Street Name__________________________________ Apartment # _______ City ______________________ State/Province____________ Zip/Postal Code _____________________ Country ________________________ DATE FROM: ______/________ DATE TO: ______/_____
Street Number _____ Street Name__________________________________ Apartment # _______ City ______________________ State/Province____________ Zip/Postal Code _____________________ Country ________________________ DATE FROM: ______/________ DATE TO: ______/_____
Street Number _____ Street Name__________________________________ Apartment#_______ City ______________________ State/Province____________ Zip/Postal Code _____________________
Country ________________________ DATE FROM: ______/________ DATE TO: ______/_____
Street Number _____ Street Name__________________________________ Apartment #_______ City ______________________ State/Province____________ Zip/Postal Code _____________________ Country ________________________ DATE FROM: ______/________ DATE TO: ______/_____
Street Number _____ Street Name__________________________________ Apartment #_______ City ______________________ State/Province____________ Zip/Postal Code _____________________ Country ________________________
SUPPLEMENTAL EMPLOYMENT HISTORY PAGE **Please write in your Employment History for the previous five (5) years. Leave no gaps. If you were/are a student write in “Student”. If you were/are unemployed write in “unemployed”. Current / Previous Date From: _______/_______ Date to: _______/_______
Occupation: ________________________________________ Employer: __________________________________________ Employer Phone number: (_____)_______-_________ Employer Address: _________________________________________________ City:__________________________________________ Country: ____________________________________________ State/Province: _______________________________________ Zip/Postal Code__________________________________________ Current / Previous Date From: _______/_______ Date to: _______/_______
Occupation: ________________________________________ Employer: __________________________________________ Employer Phone number: (_____)_______-_________ Employer Address: _________________________________________________ City:__________________________________________ Country: ____________________________________________ State/Province: _______________________________________ Zip/Postal Code__________________________________________
Current / Previous Date From: _______/_______ Date to: _______/_______
Occupation: ________________________________________ Employer: __________________________________________ Employer Phone number: (_____)_______-_________ Employer Address: _________________________________________________ City:__________________________________________ Country: ____________________________________________ State/Province: _______________________________________ Zip/Postal Code __________________________________________ Current / Previous Date From: _______/_______ Date to: _______/_______
Occupation: ________________________________________ Employer: __________________________________________ Employer Phone number: (_____)_______-_________ Employer Address: _________________________________________________ City:__________________________________________ Country: ____________________________________________ State/Province: _______________________________________ Zip/Postal Code __________________________________________
FAST TRAVEL FORM PLEASE FILL OUT THIS FORM If you have travelled outside of North America (Canada, the United States and its territories, and Mexico) in the past five years you must list the countries where you have travelled. The list does not have to follow any order but it must include all trips. Please note that visits to England, Scotland, Wales, or Northern Ireland should be labelled as “United Kingdom”. If you have visited a particular country more than once, you only have to list the country one time. ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________
Immigroup Inc. 1180 Danforth Ave, Toronto, ON M4J 1M3 Phone: 1-866-760-2623 Fax: 416-640-2650 Email: [email protected]
FAST CARD
IMMIGROUP ORDER FORM INSTRUCTIONS
Read all instructions and follow carefully 1. Please complete one (1) FAST CARD application form per person. Complete the address and employment fields for the last five (5) years in full, leaving NO gaps (including when unemployed or as a student). If you require additional space, please use the 'Required Supplementary Information' forms provided. 2. Make clear copies of your valid citizenship and identity documents (i.e. passport, birth certificate, PR card, work/study permit, etc.). If applicable, make copies of your drivers license and vehicle registration. 3. Complete this order form in full, ensuring you have included all requirements on the 'FAST CARD Package Checklist'. 4. Send your entire completed package using one of the following methods: FAX application package to 416-640-2650 OR SCAN AND EMAIL your entire application package to [email protected] with the subject line: (Name of Applicant) FAST CARD Application OR MAIL/DROP OFF your entire application package to our head office at: 1180 DANFORTH AVE, TORONTO, ON CANADA M4J 1M3
FAST CARD PACKAGE CHECKLIST
Include the following documents in your FAST CARD package FAST CARD APPLICATION FORM completed and signed (all forms must be included, even if blank) IMMIGROUP ORDER FORM - applications submitted without this form will not be processed COPY OF VALID CITIZENSHIP DOCUMENT -i.e. passport, citizenship card, birth certificate, etc. COPY OF VALID ADMISSIBILITY DOCUMENT -i.e. passport, PR card, work/study permit, etc. COPY OF VALID DRIVERS LICENSE -you must have a drivers license for this application COPY OF VEHICLE REGISTRATION -if applicable APPLICATIONS SUBMITTED WITHOUT THIS ORDER FORM WILL NOT BE PROCESSED
ADDITIONAL INFORMATION
* Initial review of your application entails background checks in both Canada and the US * Once you have been conditionally approved, we will contact you to schedule an interview; you must schedule this interview within 30 days of approval * Once you attend your interview and have been approved, your card will be mailed to you at the address you provide * Sending incomplete applications will delay processing
SERVICE OPTIONS
BASIC SERVICE PREMIUM SERVICE
$219.50 $150 service fees
$19.50 HST (harmonized sales tax) $50 CDN government fees*
$332.50 $250 service fees
$32.50 HST (harmonized sales tax) $50 CDN government fees*
AVERAGE PROCESSING TIME** 6-8 WEEKS
*after applicable exchange rates **Timeline refers to initial review by the government
AVERAGE PROCESSING TIME** 2-4 WEEKS
*after applicable exchange rates **Timeline refers to initial review by the government. If initial review is not complete within 3 weeks, you will be refunded $113
By signing below I agree to be charged the applicable service fees to the credit card I have provided.
We accept Visa, Mastercard, Amex, and brank drafts (call for this method) as acceptable methods of payment
CREDIT CARD INFORMATION
DISCLAIMER
By signing below applicant agrees to all of the following conditions
*I assert that I have read and agreed to the terms and conditions as listed on http://www.immigroup.com/disclaimer.php *Immigroup is not responsible for applications lost in the mail or improperly submitted by email or fax *Immigroup is not responsible for applications that are denied *Immigroup is not responsible for delays caused by incomplete applications *Basic service fees are non-refundable once applications are submitted to the government *A portion of 'Premium Service' fees are refunded only if initial processing exceeds 3 weeks from the date your credit card was charged * Government fees are non-refundable in all cases *I assert that I understand I am using Immigroup to apply for my NEXUS card *I agree to being charged the total fees according to the service I have selected to the credit card provided.
Cardholder name: Card number: Expiry date (mm/yy): Cardholder signature: CVV code:
What is the CVV code? www.sti.nasa.gov/cvv
SIGN HERE:
Immigroup Inc. 1180 Danforth Ave, Toronto, ON M4J 1M3 Phone: 1-866-760-2623 Fax: 416-640-2650 Email: [email protected]
FAST CARD COMMERCIAL DRIVER APPLICATION
FIRST TIME APPLICANT RENEWAL/REAPPLICATION PLEASE PROVIDE PREVIOUS FAST ID # IF YOU HAVE APPLIED THROUGH GOES BEFORE PLEASE GIVE USER ID AND PASSWORD
PERSONAL DATA
LAST NAME OTHER NAMES USED DATE OF BIRTH PREFERRED INTERVIEW LOCATION DRIVERS LICENCE NUMBER FIRST NAME OTHER NAMES USED COUNTRY OF BIRTH EMAIL ADDRESS DRIVERS LICENCE EXPIREY DATE MIDDLE NAME IF USED GENDER TOWN AND PROVINCE/STATE HOME TELEPHONE CELL PHONE
ISSUING PROVINCE / STATE
IS THIS AN ENHANCED DRIVERS LICENCE?
IS THIS A COMMERCIAL DRIVER LICENCE?
DO YOU HAVE CLEARANCE FOR HAZARDOUS MATERIALS (HAMZAT)?
CITIZENSHIP DATA
SPECIFY IF OTHER CANADIAN PASSPORT # PASSPORT # USA EXPIRY DATE EXPIRY DATE ISSUING COUNTRY ISSUING COUNTRY
ONLY COMPLETE THIS SECTION IF YOU DO NOT HAVE A CANADIAN OR US PASSPORT
PR CARD # BIRTH CERTIFICATE # CITIZENSHIP CARD#
5 YEAR ADDRESS HISTORY
CURRENT ADDRESS FROM (YEAR/MONTH) CITY # STREET APT #
POST / ZIP CODE
PROVINCE / STATE +COUNTRY
MAILING ADDRESS IF DIFFERENT TO YOUR CURRENT ADDRESS
PREVIOUS ADDRESS FROM (YEAR/MONTH) CITY TO (YEAR/MONTH) # STREET
POST / ZIP CODE
PROVINCE / STATE +COUNTRY
PREVIOUS ADDRESS FROM (YEAR/MONTH) CITY
TO (YEAR/MONTH)
#
STREET
POST / ZIP CODE
PROVINCE / STATE +COUNTRY
PREVIOUS ADDRESS FROM (YEAR/MONTH) CITY
TO (YEAR/MONTH)
#
STREET
POST / ZIP CODE
PROVINCE / STATE +COUNTRY
PREVIOUS ADDRESS FROM (YEAR/MONTH) CITY
TO (YEAR/MONTH)
#
STREET
POST / ZIP CODE
PROVINCE / STATE +COUNTRY
PREVIOUS ADDRESS FROM (YEAR/MONTH) CITY
TO (YEAR/MONTH)
#
STREET
POST / ZIP CODE
PROVINCE / STATE +COUNTRY
5 YEAR EMPLOYMENT AND UNEMPLOYMENT HISTORY
MINORS UNDER 18 NEED NOT COMPLETE THIS SECTION. IF YOU ARE RETIRED, A STUDENT OR UNEMPLOYED WE NEED TO KNOW THE FROM AND TO DATE: NO OTHER DETAILS ARE REQUIRED.
CURRENT EMPLOYMENT FROM (YEAR/MONTH) EMPLOYER’S ADDRESS OCCUPATION EMPLOYER’S NAME
POST / ZIP CODE
CITY + PROVINCE / STATE
EMPLOYER’S PHONE NUMBER PREVIOUS EMPLOYMENT FROM (YEAR/MONTH) EMPLOYER’S NAME POST / ZIP CODE PREVIOUS EMPLOYMENT FROM (YEAR/MONTH) EMPLOYER’S NAME TO (YEAR/MONTH) TO (YEAR/MONTH) OCCUPATION
EMPLOYER’S ADDRESS CITY + PROVINCE / STATE OCCUPATION EMPLOYER’S PHONE NUMBER
EMPLOYER’S ADDRESS
POST / ZIP CODE
CITY + PROVINCE / STATE
EMPLOYER’S PHONE NUMBER
PREVIOUS EMPLOYMENT FROM (YEAR/MONTH)
TO (YEAR/MONTH)
OCCUPATION
EMPLOYER’S NAME
EMPLOYER’S ADDRESS
POST / ZIP CODE
CITY + PROVINCE / STATE
EMPLOYER’S PHONE NUMBER
PREVIOUS EMPLOYMENT FROM (YEAR/MONTH)
TO (YEAR/MONTH)
OCCUPATION
EMPLOYER’S NAME
EMPLOYER’S ADDRESS
POST / ZIP CODE
CITY + PROVINCE / STATE
EMPLOYER’S PHONE NUMBER
ADDITIONAL INFORMATION
Have you ever been convicted of an offense in any country for which you have not received a pardon?
NO YES
Have you ever received a waiver of inadmissibility to the U.S. from a U.S. government agency?
NO YES
Have you ever been approved by Citizenship and Immigration Canada for rehabilitation because of past criminal activity?
NO YES
Have you ever been found in violation of customs or immigration laws or other federal import laws?
NO YES
IF YOU HAVE ANSWERED YES TO ANY QUESTION, PLEASE GIVE DETAILS:
CERTIFICATION
I certify that all information given on this application and in support of this application was provided voluntarily and is true and complete. I understand that any information on this application, including any supporting documentation, background information and biometric data will be shared among Customs and Immigration authorities in both Canada and the U.S. and among law enforcement and other government agencies in accordance with applicable laws. I certify that I have read, understood and agree to abide by all conditions required for use of the FAST program, including all instructions and notices accompanying this application.
Print name
Date
Signature
FEE PAYMENT
Immigroup Fee: CAD $157.50 (includes 5% GST)
Government Fee: CAD/USD $50 I enclose a certified cheque or money order VISA
AMEX
MASTERCARD
CREDIT CARD NUMBER
CVV CODE
EXPIRY DATE
CARD HOLDER’S NAME
PLEASE ATTACH READABLE COPIES OF SUPPORTING DOCUMENTS FOR VERIFICATION
SUPPLEMENTAL ADDRESS HISTORY ** PLEASE LIST YOUR ADDRESS HISTORY FOR THE PAST FIVE (5) YEARS. LEAVE NO GAPS** DATE FROM: ______/________ DATE TO: ______/______
Street Number _____ Street Name__________________________________ Apartment # _______ City ______________________ State/Province____________ Zip/Postal Code _____________________ Country ________________________ DATE FROM: ______/________ DATE TO: ______/_____
Street Number _____ Street Name__________________________________ Apartment # _______ City ______________________ State/Province____________ Zip/Postal Code _____________________ Country ________________________ DATE FROM: ______/________ DATE TO: ______/_____
Street Number _____ Street Name__________________________________ Apartment#_______ City ______________________ State/Province____________ Zip/Postal Code _____________________
Country ________________________ DATE FROM: ______/________ DATE TO: ______/_____
Street Number _____ Street Name__________________________________ Apartment #_______ City ______________________ State/Province____________ Zip/Postal Code _____________________ Country ________________________ DATE FROM: ______/________ DATE TO: ______/_____
Street Number _____ Street Name__________________________________ Apartment #_______ City ______________________ State/Province____________ Zip/Postal Code _____________________ Country ________________________
SUPPLEMENTAL EMPLOYMENT HISTORY PAGE **Please write in your Employment History for the previous five (5) years. Leave no gaps. If you were/are a student write in “Student”. If you were/are unemployed write in “unemployed”. Current / Previous Date From: _______/_______ Date to: _______/_______
Occupation: ________________________________________ Employer: __________________________________________ Employer Phone number: (_____)_______-_________ Employer Address: _________________________________________________ City:__________________________________________ Country: ____________________________________________ State/Province: _______________________________________ Zip/Postal Code__________________________________________ Current / Previous Date From: _______/_______ Date to: _______/_______
Occupation: ________________________________________ Employer: __________________________________________ Employer Phone number: (_____)_______-_________ Employer Address: _________________________________________________ City:__________________________________________ Country: ____________________________________________ State/Province: _______________________________________ Zip/Postal Code__________________________________________
Current / Previous Date From: _______/_______ Date to: _______/_______
Occupation: ________________________________________ Employer: __________________________________________ Employer Phone number: (_____)_______-_________ Employer Address: _________________________________________________ City:__________________________________________ Country: ____________________________________________ State/Province: _______________________________________ Zip/Postal Code __________________________________________ Current / Previous Date From: _______/_______ Date to: _______/_______
Occupation: ________________________________________ Employer: __________________________________________ Employer Phone number: (_____)_______-_________ Employer Address: _________________________________________________ City:__________________________________________ Country: ____________________________________________ State/Province: _______________________________________ Zip/Postal Code __________________________________________
FAST TRAVEL FORM PLEASE FILL OUT THIS FORM If you have travelled outside of North America (Canada, the United States and its territories, and Mexico) in the past five years you must list the countries where you have travelled. The list does not have to follow any order but it must include all trips. Please note that visits to England, Scotland, Wales, or Northern Ireland should be labelled as “United Kingdom”. If you have visited a particular country more than once, you only have to list the country one time. ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________
