I-129S, Nonimmigrant Petition Based on Blanket L Petition (United States)
This form is a petition for a nonimmigrant worker to work in the United States. The form provided here is simply a sample of what the actual Form I-129S looks like.
Department of Homeland Security
U.S. Citizenship and Immigration Services
I-129S, Nonimmigrant Petition Based on Blanket L Petition
Part 1. Information about employer.
Sponsoring Company or Organization's Name _______________________________
Address - ATTN: _______________________________
Street Number and Name _______________________________
Room/Suite # _______________________________
City or Town _______________________________
State or Province _______________________________
Country _______________________________
Zip/Postal Code _______________________________
Part 2. Information about employment.
This alien will be a:
a. ____ manager/executive
b. ____ specialized knowledge professional
Blanket petition approval number:
_______________________________
Part 3. Information about employee.
Family Name _______________________________
Given Name _______________________________
Middle Name _______________________________
Foreign Address: Street Number and Name _______________________________
Apt. # _______________________________
City or Town _______________________________
State or Province _______________________________
Country _______________________________
Zip/Postal Code _______________________________
Date of Birth (mm/dd/yyyy) _______________________________
Country of Birth _______________________________
Country of Citizenship _______________________________
Part 4. Additional information about the employment.
Address: Street Number and Name _______________________________
Room/Suite # _______________________________
City or Town _______________________________
State or Province _______________________________
Country _______________________________
Zip/Postal Code _______________________________
Date of intended employment (mm/dd/yyyy) _______________________________
From: _______________________________
To: _______________________________
Weekly Wage $_______________________________
Hours Per Week _______________________________
Title and detailed description of duties to be performed _______________________________
Give the alien's dates of prior periods of stay in the United States in a work authorized capacity and the type of visa. _______________________________
Give the alien's dates of employment and job duties for the immediate prior three years. _______________________________
Summarize the alien's education and other work experience. _______________________________
Part 8. Signature. Read the information on penalties in the instructions before completing this section.
I certify, under penalty of perjury under the laws of the United States of America, that this petition and the evidence submitted with it are all true and correct. I am filing this on behalf of an organization, and I certify that I am empowered to do so by that organization. If this petition is to extend a prior petition, I certify that the proposed employment is under the same terms and conditions as in the prior approved petition. I authorize the release of any information from my records, or from the petitioning organizations records that the Bureau of Citizenship and Immigration Services needs to determine eligibility for the benefit being sought.
Signature _______________________________
Date (mm/dd/yyyy) _______________________________
Daytime Telephone Number (with area code) _______________________________
Please Note: If you do not completely fill out this form or fail to submit required documents listed in the instructions, the person(s) petitioned for may not be found eligible for the requested benefit and this petition may be denied.
Part 9. Signature of person preparing form if other than above. (Sign below.)
I declare that I prepared this application at the request of the applicant and it is based on all information of which I have knowledge.
Signature _______________________________
Print or Type Your Name _______________________________
Fax Number (if any) _______________________________
Date (mm/dd/yyyy) _______________________________
Firm Name and Address _______________________________
Daytime Telephone Number (with area code) _______________________________
-----------------------------
FOR USCIS USE ONLY
Returned ___________________ Date
Resubmitted ___________________ Date
Reloc Sent ___________________ Date
Reloc Rec'd ___________________ Date
Receipt ___________________
____ Petitioner Interviewed on ___________________
____ Beneficiary Interviewed on ___________________
-----------------------------
Approved as:
____ manager/executive
____ specialized knowledge
Validity Dates: ___________________
From: ___________________
To: ___________________
Denied (give reason) _______________________________
Action Block
To Be Completed By
Attorney or Representative, if any.
____ Fill in box if G-28 is attached to represent the petition.
ATTY State License # _______________________________