Country 国家 CHINA Monthly Income in Local Currency (if 5000 employed) 月收入（如果有工作）当地货币 Does Not Apply Briefly describe your duties: 简要描述您的工作职责 Were you previously employed? 您之前有工作吗？ Employer Name 单位名称 Employer Street Address (Line 1) 地址 Employer Street Address (Line 2) Optional City 城市 State/Province 洲/省 .Postal Zone/ZIP Code 邮政编码 .Country 国家 Telephone Number 电话 Job Title 职位 Supervisor's Surname主管姓氏 Supervisor's Given Names主管名字 Employment Date From工作开始日期 Employment Date To 工作结束日期 Briefly describe your duties: 请简要描述您的工作职责： Senior Lecturer of Education Center，Shenyang Bureau Of Surueying And Mapping. Yes No Employer /Employment Information: 单位/工作信息 SHANYANG FACTORY 1 DONGTAJIE SHENYANG LIAONING Does Not Apply . 110043 Does Not Apply CHINA 024- 88484848 Engineer ZHANG SAN 01/FEB/1982 01/JUL/1989 Engineer，Responsible for quality control of metal materials MINING MACHINERY Have you attended any educational institutions Yes at a secondary level or above? 您是否在任何相当于中学水平或以上的教育机构里学习过？ You must answer Yes to this question if you have ever attended, for any length of time, a high school/secondary school (or its equivalent in your country) or college, university, graduate school, a doctoral program, or a vocational program. 如果您曾上过高中/职业学校（或相当于本国这个程度的教育院校）、或大专、大学、研究生学校、博士项目或职业项目等，不管多长时间，您对这个问题均须回答“是”。 Provide the following information on the educational institution(s) you have attended. 请提供你所经历的教育机构的相关信息。 Name of Institution 学校名称 Street Address (Line 1) Street Address (Line 2) *Optional City State/Province 洲/省 Does Not Apply Postal Zone/ZIP Code 邮政编码 Country Course of Study
Northeastern University 3 WENHUALU SHENYANG LIAONING 110819 CHINA Metal Material 26
Date of Attendance From Date of Attendance To 01/ FEB/1978 01/ FEB/1982 ditional Work/Education/Training Information其他工作/教育/培训信息
NOTE: Provide the following work, education, or training related information. Provide complete and accurate information to all questions that require an explanation. 注意：请提供以下有关工作、学历或培训的信息。 对于所有要求解释的问题， 请提供完整、准确的信息。 Do you belong to a clan or tribe? 您是否属于一个宗族或者部落？ No
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Provide a List of Languages You Speak 请列出您所说语言的种类 CHINESE Have you traveled to any countries within the last five years? 最近五年里您是否去过其他国家？ No Have you belonged to, contributed to, or worked for any professional, social, or charitable organization?您是否从属于任何一个专业的、社会或慈善组织？并为其做过贡献、或为其工作过？No Do you have any specialized skills or training, such as firearms, explosives, nuclear, biological, or chemical experience? 您是否具有特殊技能或接受过特殊培训，例如有关枪械、炸药、 核装置、 生物或化学方面的经验？No Have you ever served in the military? 您是否曾经在军队服役？No Have you ever served in, been a member of, or been involved with a paramilitary unit, vigilante unit, rebel group, guerrilla group, or insurgent organization? 你是否曾经服务于或参与过准军事性单位、治安团体、造反组织、游击队或暴动组织，或曾经是其成员之一？No Security and Background: Part 1 安全和背景: 第一部分
NOTE: Provide the following security and background information. Provide complete and accurate information to all questions that require an explanation. A visa may not be issued to persons who are within specific categories defined by law as inadmissible to the United States (except when a waiver is obtained in advance). Are any of the following applicable to you? While a YES answer does not automatically signify ineligibility for a visa, if you answer YES you may be required to personally appear before a consular officer. 注意：请提供以下安全与背景信息。对于所有要求解释的问题，请提供完整、准确的信息。对于那些属于法律特定范畴内不许入境的人员，我们不能颁发签证（提前获得豁免的申请人除外）。下列情况有适用于您的吗？如果您回答“是”，这并不意味着您就无资格获得签证，但是您可能需要与签证官员进行面谈。
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Do you have a communicable disease of public health significance? (Communicable diseases of public significance include chancroid, gonorrhea, granuloma inguinale, infectious leprosy, lymphogranuloma venereum, infectious stage syphilis, active tuberculosis, and others diseases as determined by the Department of Health and Human Services.)从公共卫生意义上看，您是否患有传染性疾病？（这类疾病可包括软下疳、淋病、肉芽肿、腹股沟、传染性麻风病、淋巴肉芽肿、梅毒感染阶段、活动性肺结核等，及其它卫生和人类服务部规定的传染疾病）No Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare of yourself or others? 您是否患有对其他人的人身安全及利益造成威胁的精神或身体疾病？No Are you or have you ever been a drug abuser or addict? 您是否或曾经滥用药物并上瘾？No Security and Background: Part 2 安全和背景： 第二部分
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NOTE: Provide the following security and background information. Provide complete and accurate information to all questions that require an explanation. A visa may not be issued to persons who are within specific categories defined by law as inadmissible to the United States (except when a waiver is obtained in advance). Are any of the following applicable to you? While a YES answer does not automatically signify ineligibility for a visa, if you answer YES you may be required to personally appear before a consular officer. 注意：请提供以下安全与背景信息。对于所有要求解释的问题，请提供完整、准确的信息。属于法律规定的特定类别的申请者，即被认为不可进入美国的申请者可能无法获得签证（提前获得豁免的申请人除外）。下列情况是否适用于您？如果您回答“是”，并不直接意味着您无资格获得签证，但是您可能被要求与签证官员进行面谈。 Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, amnesty, or other similar action? 您是否曾经因违法或犯罪被捕或被判刑，即使后来您受到了宽恕、赦免或其它类似的裁决？ No Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances? 您是否曾经违反或密谋违反有关管控物资方面的法律？ No Are you coming to the United States to engage in prostitution or unlawful commercialized vice or have you been engaged in prostitution or procuring prostitutes within the past 10 years? 您是来美国从事卖淫或非法商业性交易吗？在过去十年中，您是否从事过卖淫或组织介绍过卖淫？ No Have you ever been involved in, or do you seek to engage in, money laundering? 您是否曾经参与或意图从事洗钱活动？ No Have you ever committed or conspired to commit a human trafficking offense in the United States or outside the United States? 您曾在美国或美国以外的地方犯有或密谋人口走私罪吗？ No Have you ever knowingly aided, abetted, assisted or colluded with an individual who has committed, or conspired to commit a severe human trafficking offense in the United States or outside the United States? 你有没有故意资助，教唆，协助或勾结某个人，而这个人在美国或美国以外的地方曾犯有、或密谋了一严重的人口走私案？ No Are you the spouse, son, or daughter of an individual who has committed or conspired to commit a human trafficking offense in the United States or outside the United States and have you within the last five years, knowingly benefited from the trafficking activities? 您是一曾在美国或美国以外犯有或密谋人口走私案犯的配偶或儿女吗？您在最近5年里是否从走私活动中获得过好处？ No Security and Background: Part 3安全和背景： 第三部分 30