Form I-765 - Liberian Deferred Enforced Departure - U.s. Department Of Justice printable pdf download

Form I-765 - Liberian Deferred Enforced Departure - U.s. Department Of Justice

OMB Approval No. 1115-0220

Liberian Deferred Enforced Departure

U.S. Department of Justice

(DED) Supplement to Form I-765

Immigration and Naturalization Service

I am applying for an employment authorization document (EAD) based on Liberian Deferred Enforced Departure (DED):

Part A. Information About You.

3. Middle Name

2. First Name

1. Complete Last Name

4. Alien Registration Number (A-Number) or I-94 Number (if known)

Part B. Application Type.

I am applying for an employment authorization based upon the fact that I am a national or citizen of Liberia who was present in the

United States as of September 29, 2001. Since that date I have been continuously present in the United States, or if I departed from

the United States, I obtained advance parole prior to all departures, or was inspected or admitted. (If you traveled outside the United

States after September 29, 2001, explain below.)

Part C. Additional Eligibility Information.

1. Have you ever been arrested, convicted and sentenced or imprisoned in your country, any other country, or the United States?

YES (If YES, for each instance specify below the dates, locations, and reasons or charges. Attach documents, if

available, referring to these incidents. Documents showing the disposition of a conviction may be valuable

in expediting processing and eliminating the need for personal interview. Do not report non-criminal

traffic or immigration arrests and violations.)

2. Have you ever ordered, incited, assisted or otherwise participated in the persecution of any person because of his or her race,

religion, nationality, membership in a particular social group, or political opinion?

YES (If YES, describe below

each such incident and your own involvement in it.)

3. Did you settle in a country other than Liberia prior to arriving in the United States?

YES

4. Have you ever returned to Liberia or your country of last residence outside the United States since September 29, 2001?

YES (If YES, specify below your departure and return dates, countries visited, reason for travel, and description of

INS travel authorization for each such trip. Provide copies of available related documentation, especially INS documents and

the pages of your passport indicating your identity and all entries and departures.)

Form I-765D (02/14/02)Y

Form I-765 - Liberian Deferred Enforced Departure - U.s. Department Of Justice