Full name and gender Other names or aliases, if any Date and city of birth (according to passport) Country of nationality and passport Other nationality including historic, if any Passport number and expiration date Address Parents' names, if known Employer's name and address, if any Emergency contact, name, phone and address U.S. point of contact information (a person, business or hotel one intends to visit) Whether the applicant is a member of Global Entry Applicants must also specify whether any of the following applies to them by way of yes/no answers. Applications will be denied if the applicant: Has a physical or mental disorder posing a threat to others, or is a drug abuser, or has one of certain contagious diseases such as cholera, diphtheria, tuberculosis, plague, yellow fever, ebola or severe acute respiratory illnesses[1] Has ever been arrested or convicted for a crime that resulted in serious damage to property, or serious harm to another person or government authority Has ever violated any law related to possessing, using, or distributing illegal drugs Plans to engage in or has ever engaged in terrorist activities, espionage, sabotage, or genocide Has committed fraud or misrepresented oneself or others to obtain, or assist others to obtain, a visa or entry into the United States Intends to seek employment in the United States or was previously employed in the United States without prior permission from the U.S. government Has been denied a U.S. visa, or been refused admission to the United States at a U.S. port of entry Has previously stayed in the United States longer than the admission period Has traveled to Iran, Iraq, Libya, North Korea, Somalia, Sudan, Syria or Yemen on or after March 1, 2011