1、U.S. Department of StateCONTACT INFORMATION AND WORK HISTORYFOR NON IMMIGRANT VISA APPLICANTPLEAST TYPE OR PRINT YOUR ANSWERS IN THE SPACE PROVIDED BELOW EACH ITEMPLEASE ATTACH AN ADDITIONAL SHEET IF YOU NEED MORE SPACE TO CONTINUE YOUR ANSWERS1. Last Name(s) First Name(s) Middle Name Lu Wei 2 Date
2、of Birth (mm-dd-yyyy) 3. Place of Birth11/22/1980 CountryChinaCity/TownBaishanState/ProvinceJilin4. Permanent Home Address and Telephone Number (include apartment number, street, city, state or province, postal zone, and country) Add: 8/F, 6 Haidian Zhongjie, Haidian Distr., Beijing, 100080, ChinaTe
3、l:86-10-806160605. Full Name and Address of Spouse (if applicable) (postal box number unacceptable)Name (Last, First, Middle)N/AAddressTelephone Number6. Full Names and Addresses of Children, Parents, and Siblings (postal box number unacceptable)Name (Last, First, Middle)Lu HuaWang MeiAddressBaishan
4、 City, Jilin, 100046Baishan City, Jilin 100046RelationshipFatherMotherTelephone Number86-439-2222286-439-222227. List at Least Two Contacts in Applicants Country of Residence Who Can Verify Information About Applicant (do not list immediate familymembers or other relatives) (postal box number unacce
5、ptable)Name (Last, First, Middle)Li LiWu Tao AddressBeijing, China 100080Beijing, China 100080Telephone Number86-1111111118611111111Paperwork Reduction Act Statement*Public reporting burden for this collection of information is estimated to average 1 hour per response, including time required for se
6、arching existing data sources, gathering the necessary data, providing the information required, and reviewing the final collection. You do not have to provide the information unless this collection displays a currently valid OMB number. Send comments on the accuracy of this estimate of the burden a
7、nd recommendations for reducing it to: U.S. Department of State (A/RPS/DIR) Washington, DC 20520.DS-158 Page 1 of 208-2006OMB APPROVAL NO. 1405-0144Expires: 08/31/09Estimated Burden: 1 hourWORK EXPERIENCE - PRESENTJob Title: N/A Date (mm-dd-yyyy) From Date (mm-dd-yyyy) To Employers Name and Address:
8、Telephone Number Describe Your DutiesWORK EXPERIENCE - PREVIOUSJob Title: N/A Date (mm-dd-yyyy) From Date (mm-dd-yyyy) To Employers Name and Address:Telephone Number Describe Your DutiesWORK EXPERIENCE - PREVIOUSJob Title: N/A Date (mm-dd-yyyy) From Date (mm-dd-yyyy) To Employers Name and Address:Te
9、lephone Number Describe Your DutiesWORK EXPERIENCE - PREVIOUSJob Title: N/A Date (mm-dd-yyyy) From Date (mm-dd-yyyy) To Employers Name and Address:Telephone Number Describe Your DutiesI certify that I have read and understood all the questions set forth in this form and the answers I have furnished on this form are true and correctto the best of my knowledge and belief. I understand that any false or misleading statement may result in the permanent refusal of a visa or denial of entry into the United States.APPLIANTS SIGNATURE DATE (mm-dd-yyyy)DS-158 Page 2 of 208-2006
