Name:               Email:     
Cell Phone:        Phone:  

If you have lived in more than 1 Residence in the past five years please post last two beneath current address.

Current Address:       
Previous Address  1:
Previous Address  2:

The property you currently reside at:
You ownYou rent Assisted Living
Other  Explain:

If you answered rent, Do you have a current contract with the Landlord?
Yes  No

What is your marital status?
SingleMarriedDivorced
SeparatedWidowedOther

Explain:

Have you been married previously?
Yes  No

Do you currently have to pay spousal or child support?
Yes  No

Is your income:
    Less than $15000
  $15000 to $25000
  $25000 to $35000
  Greater than $35000

Have you filed income taxes for the past five years?
Yes  No

Do you have a United States current valid Passport?
Yes  No

If  no, what country are you a citizen of?


Are you a legal permanent resident of the United States?
Yes  No

Have you ever traveled to a country embargoed by the United States?
Yes  No



If you have had more than one employer in the past five years please post below.

Current Employer:   
Past Employer 1:      
Past Employer 2:      

Is the vehicle you intend to use with SENTRI in your name?
Yes  No

Does your vehicle have any problems or defects?
Yes  No

Other Explain: Are all the vehicles lights and signals in working order? Is your windshield  cracked or shattered?

Have you ever been convicted of a crime or failed to appear in court.
Yes  No

Has any of your family ever been convicted of a crime or failed to appear in court.
Yes  No

Have you ever been involved with or have known of criminal activity that you did not report?
Yes  No
 

Credit Card Information:

Card Type:     VISA MASTERCARD AMEX DISCOVER

Card Number:

Expiration Date:

Security  Code:  

3 Digit Number on Back of Card-  Last 3 numbers for Mastercard, Visa, and Discover.

For Amex Cards the security code is a 4 digit number on the front of the card.

 Security Code Examples: Click to view examples

This Page is secured with SSL-secure socket layers to protect your information.

Your Charge Card will be charged for the amount of $150.00 dollars to process the screening application

 After payment has been received the prescreening application will be reviewed and you will receive an email verifying that payment has been received along with follow-up information.

Before pushing the send button please review all questions have been answered to the best of your knowledge and truthfully.

By Pushing the send button you are submitting information that will be considered a legal acceptance of terms for a online screening application.
 

We are not affiliated with the Federal Government or the U.S. Border and Protection Agency. We provide a screening process enabling you to have a informed decision if you should apply to the SENTRI PROGRAM. We process documents and process the G.O.E.S. Applications for anyone that signs up under the Go Sentri Website.