mautic.pro-immigration.org
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https://mautic.pro-immigration.org/email/view/658d0f9500132538326015
Submission: On December 28 via manual from FR — Scanned from FR
Submission: On December 28 via manual from FR — Scanned from FR
Form analysis 1 forms found in the DOM
https://payments.usafis.org/Handlers/RegisterHandler.ashx
<form target="_blank" action="https://payments.usafis.org/Handlers/RegisterHandler.ashx">
<table border="1" style="max-width:700px; border:1px solid #787878; border-collapse: collapse; font-family:Helvetica; margin:10px;">
<input type="hidden" name="utm_outsource" value="1">
<input type="hidden" name="utm_sub" value="1">
<input type="hidden" name="utm_siteidkey" value="USV16">
<input type="hidden" name="utm_pid" value="10001">
<input type="hidden" name="ccopen" value="1">
<input type="hidden" name="utm_cid" value="4">
<input type="hidden" name="utm_u" value="153484464">
<input type="hidden" name="utm_p" value="CF679">
<input type="hidden" name="utm_af" value="_emtsass05_MT">
<input type="hidden" name="utm_source" value="MAUTIC">
<input type="hidden" name="utm_medium" value="email">
<input type="hidden" name="utm_term" value="lp_payment">
<input type="hidden" name="utm_campaign" value="MAUTIC_Form0002PreAssessment_USD05_EN">
<input type="hidden" name="utm_content" value="usafis_visa_personal_form_0002_pre_assessment">
<tbody>
<tr>
<td colspan="3" style="padding:10px; text-align:center; font-size:13px; font-weight:bold;">USAFIS - FORM 0002</td>
</tr>
<tr>
<td colspan="3" style="line-height:1em; padding:5px; text-align:left; font-size:13px; font-weight:bold; background-color:#e4ebfa; color:#343434;">FORM DETAILS</td>
</tr>
<tr>
<td style="width:33%; padding:5px; text-align:left; font-size:13px;"><b>Date: <div style="padding:5px; color:#2020F0;"></div> </b></td>
<td style="width:33%; padding:5px; text-align:left; font-size:13px;"><b>Applicant ID: <div style="padding:5px; color:#2020F0;">153484464</div> </b></td>
<td style="width:33%; padding:5px; text-align:left; font-size:13px;"><b>Form Type: <div style="padding:5px; color:#2020F0;">Pre-Assessment</div> </b></td>
</tr>
<tr>
<td colspan="3" style="line-height:1em; padding:5px; text-align:left; font-size:13px; font-weight:bold; background-color:#e4ebfa; color:#343434;">PERSONAL DETAILS</td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">Name:</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;"> <input type="text" name="utm_frm_name" value="Saliou Seck" style="width:95%;"> </div> </b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">Email:</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;"> saliou.seck@eiffage.com </div> </b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">Birth date:</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;"> <input type="text" name="utm_frm_dob" value="" style="width:95%;"></div> </b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">Birth Country:</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;"> <input type="text" name="utm_frm_birth_country" value="Senegal" style="width:95%;"> </div> </b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">Education:</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;"> <input type="text" name="utm_frm_education" value="" style="width:95%;"></div> </b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">Registration Date:</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;"> </div> </b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">Registration IP:</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;"> </div> </b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">Phone Number:</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;"> <input type="text" name="utm_frm_phone" value="" style="width:95%;"> </div> </b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">Marital Status:</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;"> <input type="text" name="utm_frm_marital_status" value="" style="width:95%;"> </div> </b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">What is your highest level of education?</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;">
<select name="utm_frm_highest_education_level" style="width:250px;">
<option value="-1">Please Choose</option>
<option value="1">Haven't Graduated High School</option>
<option value="2">High School Graduate</option>
<option value="3">First Year of College</option>
<option value="4">Second Year of College</option>
<option value="5">Third Year of College</option>
<option value="6">Fourth Year of College</option>
<option value="7">Associates Degree</option>
<option value="8">Bachelor's Degree</option>
<option value="9">Bachelor's + 1 year of completed MA Studies</option>
<option value="10">Bachelor's + 2 years of completed MA Studies</option>
<option value="11">Master's Degree</option>
<option value="12">Doctorate</option>
<option value="13">PhD</option>
<option value="14">Completed vocational education/training</option>
<option value="15">Other</option>
</select>
</div></b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">Have you received a degree or certificate?</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;">
<select name="utm_frm_has_degree_or_cert" style="width:250px;">
<option value="-1">Please Choose</option>
<option value="1">No</option>
<option value="2">Yes</option>
</select>
</div></b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">Are you still studying?</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;">
<select name="utm_frm_still_studying" style="width:250px;">
<option value="-1">Please Choose</option>
<option value="1">No</option>
<option value="2">Yes</option>
</select>
</div> </b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">Total amount of years for your education since grade 1</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;">
<select name="utm_frm_total_education_years" style="width:250px;">
<option value="-1">Please Choose</option>
<option value="1">Less than 10</option>
<option value="2">10</option>
<option value="3">11</option>
<option value="4">12</option>
<option value="5">13</option>
<option value="6">14</option>
<option value="7">15</option>
<option value="8">16</option>
<option value="9">17</option>
<option value="10">18</option>
<option value="11">19</option>
<option value="12">20</option>
<option value="13">More than 20</option>
</select>
</div> </b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">Are you currently employed?</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;">
<select name="utm_frm_is_employed" style="width:250px;">
<option value="-1">Please Choose</option>
<option value="1">No</option>
<option value="2">Yes</option>
</select>
</div> </b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">Do you have proof of your employment (pay slips, reference letters, contract)?</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;">
<select name="utm_frm_has_employment_proof" style="width:250px;">
<option value="-1">Please Choose</option>
<option value="1">No</option>
<option value="2">Yes</option>
</select>
</div> </b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">Please list all languages that you currently speak:</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;"> <input type="text" name="utm_frm_spoken_languages" value="" style="width:95%;"> </div> </b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">Are you thinking of going to the United States with your family members or alone?</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;">
<select name="utm_frm_go_alone_family" style="width:250px;">
<option value="-1">Please Choose</option>
<option value="1">Alone</option>
<option value="2">With Family</option>
</select>
</div> </b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">What is the purpose of your entry and stay in the United States:</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;"> <input type="text" name="utm_frm_stay_purpose" value="" style="width:95%;"> </div> </b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">Are you seeking protection because you have suffered from persecution or fear because of: Race, Religion, Nationality, Membership in a
particular social group, Political opinion?</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;">
<select name="utm_frm_seeks_protection" style="width:250px;">
<option value="-1">Please Choose</option>
<option value="1">No</option>
<option value="2">Yes</option>
</select>
</div> </b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">Have you ever been to the United States before?</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;">
<select name="utm_frm_been_to_usa" style="width:250px;">
<option value="-1">Please Choose</option>
<option value="1">No</option>
<option value="2">Yes</option>
</select>
</div> </b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">Have you ever had problems with the law?</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;">
<select name="utm_frm_had_problems_with_law" style="width:250px;">
<option value="-1">Please Choose</option>
<option value="1">No</option>
<option value="2">Yes</option>
</select>
</div> </b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">Are you currently working for an American employer?</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;">
<select name="utm_frm_american_employer" style="width:250px;">
<option value="-1">Please Choose</option>
<option value="1">No</option>
<option value="2">Yes</option>
</select>
</div> </b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">Would you like to invest your money into a United States business?</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;">
<select name="utm_frm_invest_in_usa" style="width:250px;">
<option value="-1">Please Choose</option>
<option value="1">No</option>
<option value="2">Yes</option>
</select>
</div> </b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">Have you been awarded, or have you been nationally or internationally recognized, for excellence in the field of your outstanding activity?
</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;">
<select name="utm_frm_internationally_recognized" style="width:250px;">
<option value="-1">Please Choose</option>
<option value="1">No</option>
<option value="2">Yes</option>
</select>
</div> </b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">Have you ever been a judge of the work of others in the field of their or your specialization?</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;">
<select name="utm_frm_judged_work_of_others" style="width:250px;">
<option value="-1">Please Choose</option>
<option value="1">No</option>
<option value="2">Yes</option>
</select>
</div> </b></td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px; background-color:#DEDEDE;">Can you provide information about a crime committed in the United States?</td>
<td colspan="2" style="text-align:left; font-size:13px;"><b><div style="padding:5px; color:#2020F0;">
<select name="utm_frm_can_reveal_crime" style="width:250px;">
<option value="-1">Please Choose</option>
<option value="1">No</option>
<option value="2">Yes</option>
</select>
</div> </b></td>
</tr>
<tr>
<td colspan="3" style="line-height:1em; padding:5px; text-align:left; font-size:13px; font-weight:bold; background-color:#e4ebfa; color:#343434;">DECLARATION</td>
</tr>
<tr>
<td colspan="3" style="padding:5px; text-align:left; font-size:13px;"> By submiting the form, I hereby declare: <ul>
<li> I agree to USAFIS's
<a href="https://mautic.pro-immigration.org/r/4e202ada611cf591d137a4080?ct=YTo1OntzOjY6InNvdXJjZSI7YToyOntpOjA7czoxNDoiY2FtcGFpZ24uZXZlbnQiO2k6MTtpOjI3NDU7fXM6NToiZW1haWwiO2k6NzM2O3M6NDoic3RhdCI7czoyMjoiNjU4ZDBmOTUwMDEzMjUzODMyNjAxNSI7czo0OiJsZWFkIjtzOjc6IjEyNjk4NDEiO3M6NzoiY2hhbm5lbCI7YToxOntzOjU6ImVtYWlsIjtpOjczNjt9fQ%3D%3D&">Terms of Use</a>
</li>
<li> I acknowledge that my information will be handled as detailed in USAFIS's
<a href="https://mautic.pro-immigration.org/r/6480fb16e8f27cea205848a28?ct=YTo1OntzOjY6InNvdXJjZSI7YToyOntpOjA7czoxNDoiY2FtcGFpZ24uZXZlbnQiO2k6MTtpOjI3NDU7fXM6NToiZW1haWwiO2k6NzM2O3M6NDoic3RhdCI7czoyMjoiNjU4ZDBmOTUwMDEzMjUzODMyNjAxNSI7czo0OiJsZWFkIjtzOjc6IjEyNjk4NDEiO3M6NzoiY2hhbm5lbCI7YToxOntzOjU6ImVtYWlsIjtpOjczNjt9fQ%3D%3D&">Privacy Policy</a>
</li>
</ul>
</td>
</tr>
<tr>
<td colspan="3" style="line-height:1em; padding:5px; text-align:left; font-size:13px; font-weight:bold; background-color:#e4ebfa; color:#343434;">SUBMISSION</td>
</tr>
<tr>
<td style="padding-left:5px; width:33%; text-align:left; font-size:13px;"> Click this button to submit this form</td>
<td colspan="2" style=" padding:10px; text-align:center; font-size:13px;">
<input type="submit" value="SUBMIT FORM" style="font-family:'Calibri'; font-size:25px; color:#183bda; font-weight:bold; cursor:pointer;">
</td>
</tr>
</tbody>
</table>
</form>Text Content
Saliou - Please fill out and submit form 0002 below to begin your evaluation. USAFIS - FORM 0002 FORM DETAILS Date: Applicant ID: 153484464 Form Type: Pre-Assessment PERSONAL DETAILS Name: Email: saliou.seck@eiffage.com Birth date: Birth Country: Education: Registration Date: Registration IP: Phone Number: Marital Status: What is your highest level of education? Please Choose Haven't Graduated High School High School Graduate First Year of College Second Year of College Third Year of College Fourth Year of College Associates Degree Bachelor's Degree Bachelor's + 1 year of completed MA Studies Bachelor's + 2 years of completed MA Studies Master's Degree Doctorate PhD Completed vocational education/training Other Have you received a degree or certificate? Please Choose No Yes Are you still studying? Please Choose No Yes Total amount of years for your education since grade 1 Please Choose Less than 10 10 11 12 13 14 15 16 17 18 19 20 More than 20 Are you currently employed? Please Choose No Yes Do you have proof of your employment (pay slips, reference letters, contract)? Please Choose No Yes Please list all languages that you currently speak: Are you thinking of going to the United States with your family members or alone? Please Choose Alone With Family What is the purpose of your entry and stay in the United States: Are you seeking protection because you have suffered from persecution or fear because of: Race, Religion, Nationality, Membership in a particular social group, Political opinion? Please Choose No Yes Have you ever been to the United States before? Please Choose No Yes Have you ever had problems with the law? Please Choose No Yes Are you currently working for an American employer? Please Choose No Yes Would you like to invest your money into a United States business? Please Choose No Yes Have you been awarded, or have you been nationally or internationally recognized, for excellence in the field of your outstanding activity? Please Choose No Yes Have you ever been a judge of the work of others in the field of their or your specialization? Please Choose No Yes Can you provide information about a crime committed in the United States? Please Choose No Yes DECLARATION By submiting the form, I hereby declare: * I agree to USAFIS's Terms of Use * I acknowledge that my information will be handled as detailed in USAFIS's Privacy Policy SUBMISSION Click this button to submit this form Regina Baker Public Relations USAFIS Website: https://www.usafis.org Can't see this email properly? View in browser. No longer want to receive my emails? Unsubscribe. You are receiving this email because you have registered your email saliou.seck@eiffage.com with one of our affiliates and agreed to receive marketing content.