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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 # _______________________________

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