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Background For
  Results from US Sex Offenders Database  
  0 hits from 1 zip code for City/Town Like Last Name Like , First Name Like  
  Full Name :      
  Under new federal legislation effective March 7. 2006, Heart of Asia, is required to assist our American and Foreign clients in the relationship and communication process by asking all US Citizens or Residents for full disclosure as follows: We are mandated to collect from the US Citizen or Resident the following background information, and also conduct an electronic search on the National Sex Offender public registry and state public registry (http:.//www.nsopr.gov). This information and search result will be made available to any Foreign individuals interested in communicating with any American Citizen or Resident. In order to be able to use the services of Heart of Asia, please complete the questionaire below, sign and date.  
  1. Do you have any temporary or permanent civil protection order or restraining order issued against you?;  
  2. Do you have any Federal, State, or local arrest or conviction for homicide, murder, manslaughter, assault, battery, domestic violence, rape, sexual assault, abusive sexual contact, sexual exploitation, incest, child abuse or neglect, torture, trafficking, peonage, holding hostage, involuntary servitude, slave trade, kidnapping, abduction, unlawful criminal restraint, false imprisonment, or stalking?;  
  3. Do you have any Federal, State, or local arrest or conviction for:  
  (I) solely, principally or incidentally engaging in prostitution;
  (II) a direct or indirect attempt to procure prostitutes or persons for the purpose of prostitution or;  
  (III) receiving, in whole or in part, of the proceeds of prostitution?  
  4. Do you have any Federal, State, or local arrest or conviction for offenses related to controlled substances or alcohol?  
  5. Are you currently married?  
  6. Have you ever been married?  
  9. Have you ever sponsored the immigration to the United States of an alien to whom you were engaged or married?  
  10. Are any of your children under the ages of 18?  
  13. Please indicate all of the states in which you have resided since the age of 18  
  14. Please indicate all of the countries you have resided in since the age of 18.  
  Please review the above. If there are any inaccuracies,cick here to return to the last page to make corrections. Once all is accurate then read and sign the following:
  By entering your name below and clicking on the "I Certify and Attest" button below, you are making the following statement.  
  I hereby Certify and Attest, under penalty of perjury and false statement, that the above Background Information is true and complete. I also give my permission to Heart of Asia to release this information to all interested Foreign clients. I hereby waive any privacy rights from release of this information. I also hereby release and hold harmless and forever discharge Heart of Asia from any and all liabilities arising from my release of this information and any use of it. I further agree: (1) that should there be any changes to the Background Information I have provided above that I will resubmit to Heart of Asia updated Background Information prior to any further use of the service provided by Heart of Asia (2) that I have read the terms stated above; (3) I understand the terms stated above; (4) I intend to form a legally binding contract by entering my name and clicking on the "I Certify and Attest"; button; (5) a printout of the Background Information above will constitute a "writing" under any applicable law or regulation without regard to when or by which party the printout is made.  
  Signed: (please type your full name)  
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