United States Esta Application

UNITED STATES ESTA APPLICATION

The United States has introduced more stringent questioning to obtain an ESTA. Avocet Travel Management are still able to obtain these on your behalf but unfortunately due to the complexity of the questions we ask that you complete the following form. These are all the compulsory questions that are asked by the United States Border Force. Once we have these answers we will be in a position to apply for your ESTA on your behalf. Once you have completed the questionnaire please email to your Travel Partner for processing.

Applicants surname:
Applicants first (given name):
Are you known by any other names or aliases? / Yes / No
If yes: / Surname: / First name:
Date of birth:
City and Country of birth
Gender: / Male / Female
Parents: / Surname: / First name:
Surname: / First name:
Passport number:
Passport issuing country:
Passport issue date:
Passport expiry date:
Country of citizenship:
Are you a citizen of any other country: / Yes / No
If Yes / Country:
Passport number:
Email address:
Telephone number:
Home address:
Emergency contact / Surname: / Firstname:
Emergency contact telephone number:
Emergency contact email address:
US point of contact (can be an hotel):
Address:
Telephone number:
Do you have a current or previous employer: / Yes / No
If yes please provide the following
Employers name:
Employers address:
Employers telephone number:
Have you travelled to, or been present in Iraq, Syria, Iran or Sudan on or after 1st March 2011? / Yes / No

The following eight questions are the standard questions and we will assume the answer to be “NO” unless otherwise advised:

1) Do you have a physical or mental disorder; or are you a drug abuser or addict; or do you currently have any of the following diseases:
Chancroid
Gonorrhea
Granuloma Inguinale
Leprosy, infectious
Lymphogranuloma venereum
Syphilis, infectious
Active Tuberculosis
2) Have you ever been arrested or convicted for a crime that resulted in serious damage to property, or serious harm to another person or government authority?
3) Have you ever violated any law related to possessing, using, or distributing illegal drugs?
4) Do you seek to engage in or have you ever engaged in terrorist activities, espionage, sabotage, or genocide?
5) Have you ever committed fraud or misrepresented yourself or others to obtain, or assist others to obtain, a visa or entry into the United States?
6) Are you currently seeking employment in the United States or were you previously employed in the United States without prior permission from the U.S. government?
7) Have you ever been denied a U.S. visa you applied for with your current or previous passport, or have you ever been refused admission to the United States or withdrawn your application for admission at a U.S. port of entry?
8) Have you ever stayed in the United States longer than the admission period granted to you by the U.S. government?