Form I-129S Nonimmigrant Petition Based on Blanket L Petition

OMB No. 1615-0010; Expires 03/31/2013

Form I-129S, Nonimmigrant Petition
Based on Blanket L Petition

Department of Homeland Security
U.S. Citizenship and Immigration Services

START HERE - Please type or print in black ink.

Part 1.

For USCIS Use Only
Returned

Information About the Employer

Receipt

Date

Sponsoring Company or Organization's Name

Date
Resubmitted

Addressee - ATTN:

Date
Date

Street Number and Name

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Room/Suite Number

Relocated Sent

Date

City or Town

Date

State or Province

Relocated Received

Country

Date

Zip/Postal Code

Date

Petitioner Interviewed
on

Part 1A. Data Collection

Does the petitioner employ 50 or more individuals in the
United States?

Yes

No

If yes, are more than 50% of those employees in H-1B, L-1A,
or L-1B nonimmigrant status?

Yes

No

Part 2.

Approved as:

Manager/Executive

Specialized Knowledge

on

Information About the Proposed Employment

This alien will be a:

Beneficiary Interviewed
on

Validity Dates:
From:

To:

Action Block

a. Manager or Executive (L-1A)

b. Specialized Knowledge Professional (L-1B)
Blanket petition approval number:

Part 3. Information About the Employee
Family Name

Given Name

Middle Name

Denial Reason

Address Outside the United States: Street Number and Name Room/Suite Number
City or Town
Country
Country of Birth

State or Province
Zip/Postal Code

Date of Birth (mm/dd/yyyy)

Country of Citizenship/Nationality

To Be Completed by Attorney or
Accredited Representative, if any.
Fill in box if G-28 is attached to
represent the petition.
ATTY State License Number

Form I-129S 03/20/13 N Page 1

Part 4. Additional Information About the Proposed Employment
a.

Employment Address: Street Number and Name

b.

State or Province

c.

Dates of intended employment and wage

From (mm/dd/yyyy)

Room/Suite Number

City or Town

Country

To (mm/dd/yyyy)

Zip/Postal Code

Weekly Wage

Hours Per Week

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d.

Job title and detailed description of duties to be performed.

e.

Provide the alien's dates of prior periods of stay in the United States in a work authorized capacity and the type of visa.

f.

Provide the name and address of the alien's foreign employers, dates of employment, and job duties for the last 3 years.

g.

Summarize the alien's education and other work experience.

Form I-129S 03/20/13 N Page 2

Part 4. Additional Information About the Proposed Employment Continued
h.

If you are seeking L-1B specialized knowledge professional status for the alien, will the beneficiary be stationed primarily
offsite (at the worksite of an employer other than the petitioner or its affiliate, subsidiary, or parent)?
Yes

No

If you answered “Yes” to the preceding question, describe how and by whom the beneficiary's work will be controlled and supervised.
Include a description of the amount of time each supervisor is expected to control and supervise the work. Use an attachment if
needed.

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If you answered “Yes” to the preceding question, also describe the reasons why placement at another worksite outside the petitioner,
subsidiary, or parent is needed. Include a description of how the beneficiary's duties at another worksite relate to the need for the
specialized knowledge he or she possesses. Use an attachment if needed.

Part 5. Certification Regarding the Release of Controlled Technology or Technical Data to Foreign Persons in the
United States
Check Box 1 or Box 2 as appropriate:

With respect to the technology or technical data the petitioner will release or otherwise provide access to the alien beneficiary, the
petitioner certifies that it has reviewed the Export Administration Regulations (EAR) and the International Traffic in Arms
Regulations (ITAR) and has determined that:
1. A license is not required from either the U.S. Department of Commerce or the U.S. Department of State to release such
technology or technical data to the foreign person; or
2. A license is required from the U.S. Department of Commerce and/or the U.S. Department of State to release such technology
or technical data to the alien beneficiary and the petitioner will prevent access to the controlled technology or technical data
by the alien beneficiary until and unless the petitioner has received the required license or other authorization to release it to
the alien beneficiary.

Form I-129S 03/20/13 N Page 3

Part 6. Signature of Petitioner 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 U.S.
Citizenship and Immigration Services needs to determine eligibility for the benefit being sought.
Signature of Petitioner

Date (mm/dd/yyyy)

Printed Name of Petitioner

Daytime Telephone Number (with area code)

E-Mail Address (if any)

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NOTE: If you do not completely fill out this form or fail to submit required documents listed in the instructions, the employee
for whom you are petitioning may not be found eligible for the requested benefit and this petition may be denied.

Part 7. Signature and Contact Information of Person Preparing Form, If Other Than Above
Declaration of Preparer

I declare that this document was prepared by me at the request of the petitioner, and it is based on all information of which I have
knowledge and/or was provided to me by the above named person in response to the exact questions contained on this form. I have not
knowingly withheld any information or provided responses for the petitioner.
Signature of Preparer

Date (mm/dd/yyyy)

Printed Name of the Preparer

Daytime Telephone Number (with area code)

E-Mail Address (if any)

Preparer's Firm Name and Address

Form I-129S 03/20/13 N Page 4