8/14/2019 Frederick County (Maryland) Sheriff's Office - ICE 287(g) Interview Form

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ICE InterviewFBI#:SID#: _____________________ARJ#:.Ail: ------------------------vent#: ______________________

F]NS#: ____________________

What is your complete and correct n.a.me?Qual es SU oombre completo y c.orrecto'?

Do you use any other names?He. usado Ud. algunos otros nombres alguna om vez.?

What is yom: datt of birth?Qual ts S1l fech.a de DlIcimiento7

Ofwhat CUlltry fire you a citi.ze:oDe que pais es Ud.. ciudadano?

Do yeu h a v ~ 8 passport?TiCDC Ud. 'I.lD pasapom?

Wbe:re were you bom. Please provide the ru.me of the CityIfOWIi, State andJor municjpality?Doode Dacia? D j ~ e m e el nombre de 11.1. ciuaa.1lpuebto, e.st.a.do yJo municipio.

8/14/2019 Frederick County (Maryland) Sheriff's Office - ICE 287(g) Interview Form

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Vlhat is the name of the largest city that is the closest to your place of birth?&CnaI es que el cercano es a su lugar del nacimiento?

How far is this city from your place of birth?que distancia es esta ciudad de Sll Iugar del ............ J..L.L.U. ......................

What is your current immigration status (are legal or illegal)?Que es su estado de (es Ud. legal 0 illegal)?

are legally, documents do you as proof?Si Ud. aqui le,galmente, que documentos tiene Ud. como prueba?

Do you have any applications 1-' ..................... 0Tiene Ud. algunas applicaciones 0 solicitudes pendiente cOJ,lla Inn.:tigracion?

Have you previously been apprehended by Imm.igration? I f yes, when and where?sido arrestado antes Inmigracion? l.Si cuando y donde?

Have you ever been ordered to an Irnn:llgration hearing, deported, excluded, or removed from theOT(lleruioo a unUnidos ~ g u n a

What is yom height and weight?Cuanto y pesa

8/14/2019 Frederick County (Maryland) Sheriff's Office - ICE 287(g) Interview Form

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How long have you l i v ~ there?vivid0

.I....,.. . ........ address?es su ...........,............ ..., ..... en su

What is your . telephone number?. . . . . . . . . ... V ..L..., aqul en

States?

did you enter the last time into the United States (afoot, by plane or byentra vez en 0 en

How many

many you and onCuantas"veces ba salida usted de los &tados Unidas y en que fechas?

8/14/2019 Frederick County (Maryland) Sheriff's Office - ICE 287(g) Interview Form

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Do you have 'V""isa? WhatT1ene una. Que

Have you .ever usedusado Ud_ otros ....n ............. u ' ~ .......

Are you mmied?Ud. casado por

VJha1 is

1 1 U J ~ J l a n or ;::,e'paImeay por Ia igJes:ia? Djv()Jciado 0

.. '1 1...,1...1...:> .... a"' .." .... .,.""ciudadana(o)?

a:rey c.omo se lJaman?

cUaJ e..s)a ci110adaD;a. de S1lS n.l.Dos?

'Wb..a1 is youy father) s complete and correct DaIDe and wbat is his nationality?Qne es cl de su padre COnlp.1e1o y Correc.to y qual is la .n.acionalidad

8/14/2019 Frederick County (Maryland) Sheriff's Office - ICE 287(g) Interview Form

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your address?es JA diqecicn de so. padre?

'Wb.a.t is mother's complete 8:nd oorrect name is her nationa.lity?Que es n.ombre de su madre complete y correcto y qual e.s 1a de ella?

What is yourmoiher's date of birth? How old IS alive?Cua1 1a fecha de nacimiento de ru madre? i Cu..fu:jtos a60s tiene7 l,Ella viva7

isCual t.S la dD:reci em

members of i r o m e d i a t ~ family thatIiene Uet :algunos otros .miembrbs de Sl.l fa..ffi..uiaimmediata que viven en los Estados Unidos?

What is the name of the compaIJ'Y and telephone nurnb6r?Como se l J ~ l B _ c o m p ~ a y cua.l e.s el numero de telefoDo?

PP1.1C4C,lO.DCS lJeI1WC:Il\C COD

8/14/2019 Frederick County (Maryland) Sheriff's Office - ICE 287(g) Interview Form

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How long have you worked there?Por cuanto tiempo ha estado trabajando a1li?

How much did you ge t paid, by the hour/day/week?Cuanto Ie pagan, par horaJdia/semana?'-

Do you ow:i:l. any property in the United States?Tiene Dei. propiedad en los Estados Unidos?

Are you now or have you ever been a member of the United States military?Es Ud. ahara or ha sido alguna vez un miembro de las fuerza.s armados de los Estad6s Unidos?

Do you have any medical conditions we should be aware of?Sufre],lSted de probU:mas de salud que debemos ser consciente?

Are you preg:J;l8.llt?Esta Ud. qnbarazada?

Are you breastfeeding?Esta Vel. dando de mamar?

Are you taking any medication?Esta tomando rnedicina?

What is the name of the school you attended in your country of citizenship and what years did youattend this school?lCutil eS el nombre de la escuela a la que usted asisti6 en su pais de la ciudadania y que aDosasisti6 usted a es1a escuela?

8/14/2019 Frederick County (Maryland) Sheriff's Office - ICE 287(g) Interview Form

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What is the name of the Church yon w-w. .. l " , l Y l .......... you e.ttende.d in your county of cit:i.ze.nship?LCu.!1 es a]a e;n su de la

Date:Fec1u:

Hora.:

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