I-129S Nonimmigrant Petition Based on Blanket L Petition

USCIS
Form I-129S

Nonimmigrant Petition Based on Blanket L Petition
Department of Homeland Security
U.S. Citizenship and Immigration Services

OMB No. 1615-0010
Expires 06/30/2015

For Government Use Only
Received

Resubmitted

Relocated Sent

Relocated Received

Action Block

Fee Receipt

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Validity Dates

Beneficiary Interviewed on:

From:

Approved as:

To:

Denial Reason

Manager/Executive
Specialized Knowledge
Professional

Approval Date:

To be completed by an
attorney or accredited
representative (if any).

Select this box if
Form G-28 is
attached.

Attorney State Bar Number
(if applicable)

Attorney or Accredited Representative
USCIS Online Account Number (if any)

► START HERE - Type or print in black ink.

Part 1. Information About The Employer
(Petitioner)
1.

Petitioner's Physical Address

4.a. Street Number
and Name

Name of the Petitioner

4.b.

4.d. State

2.a. In Care Of Name (if any)

Ste.

3.

4.e. ZIP Code

2.f.

5.

Daytime Telephone Number

6.

Fax Number

7.

Email Address (if any)

8.

Web site Address (if any)

Flr.

2.d. City or Town
2.e. State

Flr.

Petitioner's Contact Information

2.b. Street Number
and Name
Apt.

Ste.

4.c. City or Town

Petitioner's Mailing Address

2.c.

Apt.

ZIP Code

Is this mailing address the same as the physical location
of the sponsoring company or organization?
Yes

No

If you answered "No" to Item Number 3., provide the
sponsoring company's or organization's physical address
in Item Numbers 4.a. - 4.e.

Petitioner's Employees in the United States
9.

Does the petitioner employ 50 or more individuals in the
United States?
Yes
No
If you answered "Yes" to Item Number 9., complete
Item Number 10.

10.

Are more than 50 percent of the petitioner's employees in
H-1B, L-1A, or L-1B nonimmigrant status?
Yes

Form I-129S 06/12/13 N

No
Page 1 of 8

Part 2. Information About the Proposed Position
and Prior Employment Periods in the United
States

Beneficiary's Full Name

The beneficiary will work as a:

4.a. Family Name
(Last Name)
4.b. Given Name
(First Name)

1.a.

Manager or Executive (L-1A)

4.c. Middle Name

1.b.

Specialized Knowledge Professional (L-1B)

Other Names Used

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Dates of Proposed Employment

Provide the beneficiary's dates of proposed employment.
2.a. Start Date (mm/dd/yyyy)
2.b. End Date (mm/dd/yyyy)

Prior Periods of Stay in the United States

If the beneficiary was previously in the United States, provide
the dates of the beneficiary's prior periods of stay for the last
seven years in a work-authorized capacity and indicate the
beneficiary's immigration status and visa category (for example,
H-1B, O-1) during the period of stay. If you need extra space to
complete this section, use the space provided in Part 10.
Additional Information.

List all other names the beneficiary has ever used, including
aliases, maiden name, and names from all previous marriages.
If you need extra space to complete this section, use the space
provided in Part 10. Additional Information.
5.a. Family Name
(Last Name)
5.b. Given Name
(First Name)

5.c. Middle Name

Beneficiary's Foreign Mailing Address

6.a. In Care Of Name (if any)

6.b. Street Number and Name or PO Box

Period of Stay 1

3.a. From (mm/dd/yyyy)

6.c.

3.b. To (mm/dd/yyyy)
4.

Apt.

Ste.

Flr.

6.d. City or Town

Nonimmigrant Status During Period of Stay

6.e. Province
6.f.

Postal Code

Period of Stay 2

6.g. Country

5.a. From (mm/dd/yyyy)
5.b. To (mm/dd/yyyy)
6.

7.

Nonimmigrant Status During Period of Stay

Is this mailing address also where the beneficiary
physically resides?
Yes

No

If you answered "No" to Item Number 7., provide the
beneficiary's physical address in Item Numbers 8.a. - 8.f.

Part 3. Information About the Beneficiary
Provide the following information about the beneficiary.
1.

Alien Registration Number (A-Number) (if any)
► A-

2.

USCIS Online Account Number (if any)
►

3.

U.S. Social Security Number (if any)
►

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Beneficiary's Foreign Physical Address

Wages and Hours of Proposed Employment

8.a. Street Number
and Name

Provide the wages per year the beneficiary will receive and the
number of hours the beneficiary will work per week for the
proposed employment. Also describe any other compensation
the beneficiary will receive, including dollar value (if
applicable).

8.b.

Apt.

Ste.

Flr.

8.c. City or Town

4.

8.d. Province

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8.e. Postal Code
8.f.

Beneficiary's Wages Per Year $

Country

5.

Beneficiary's Hours Per Week

6.

Other Compensation

Other Information About the Beneficiary

Proposed Job Title and Duties

9.

Date of Birth (mm/dd/yyyy)

10.

Gender

11.

City or Town of Birth

12.

Province or State of Birth

13.

Country of Birth

14.

Country of Citizenship or Nationality

Male

Female

Provide the job title and duties the beneficiary will perform.
Also indicate the percentage of time the beneficiary will spend
performing the duties on a daily basis. If you need extra space
to complete this section, use the space provided in Part 10.
Additional Information.
7.

Job Title

8.

Duties Performed on a Daily Basis

Primary Worksite

Part 4. Information About Proposed United
States Employment
1.

Provide the receipt number for the Blanket L petition
upon which this petition is based.
►

2.

Are you filing Form I-129, Petition for a Nonimmigrant
Worker, with this petition?
Yes
No

Proposed Employment Address for the Beneficiary
3.a. Street Number
and Name
3.b.

Apt.

9.

If you are seeking L-1B specialized knowledge
professional status for the beneficiary, will the beneficiary
work primarily offsite (at a worksite of a company or
organization other than the petitioner or its affiliate,
branch, subsidiary, or parent company)?
Yes

No

If you answered "Yes" to Item Number 9., describe how
and who will control and supervise the beneficiary's work
and why the placement is not labor for hire in Item
Numbers 10.a. - 11.
10.a. Supervisor's Name

Ste.

Flr.
10.b. Nature of Supervision and Control of the Beneficiary's
Work

3.c. City or Town
3.d. State

If you need extra space to complete this section, use the space
provided in Part 10. Additional Information.

3.e. ZIP Code

Form I-129S 06/12/13 N

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Part 4. Information About Proposed United
States Employment (continued)

Other Information About the Beneficiary's Foreign
Employment

11.

Provide the beneficiary's job titles, dates of foreign
employment, and the duties of the jobs the beneficiary
performed during the required one continuous year out of three
years. Also provide the yearly wage the beneficiary received
and the number of hours the beneficiary worked per week.

Describe the reasons why the placement of the beneficiary
at this worksite is not an arrangement to provide labor for
hire. Also include a description of how the beneficiary's
duties at this worksite relate to your need for the
specialized knowledge he or she possesses.

Job 1

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4.

Job Title

5.a. Start Date (mm/dd/yyyy)

Part 5. Information About Foreign Employment
Provide information for each qualifying foreign employer for
whom the beneficiary worked during the required one
continuous year out of three years. If you need extra space to
complete this section, use the space provided in Part 10.
Additional Information.

5.b. End Date (mm/dd/yyyy)
6.

Job Duties

7.

Wages Earned Per Year

8.

Hours Worked Per Week

Qualifying Foreign Position

Indicate the type of qualifying position the beneficiary was
employed in while working for the qualifying foreign employer.
1.a.

Manager

1.b.

Executive

Job 2

1.c.

Specialized Knowledge Professional

9.

Job Title

Qualifying Foreign Employer Name and Address

10.a. Start Date (mm/dd/yyyy)

Provide the name and address for the qualifying foreign
employer for whom the beneficiary worked.

10.b. End Date (mm/dd/yyyy)

2.

11.

Job Duties

12.

Wages Earned Per Year

13.

Hours Worked Per Week

Foreign Employer Name

$

Mailing Address
3.a. Street Number
and Name
3.b.

Apt.

Ste.

Flr.

$

3.c. City or Town
3.d. Province
3.e. Postal Code
3.f.

Country

Form I-129S 06/12/13 N

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Part 6. Certification Regarding the Release of
Controlled Technology or Technical Data to
Foreign Persons in the United States

Authorized Signatory's Contact Information
3.a. Authorized Signatory's Family Name (Last Name)

Select Item Number 1. or 2., as appropriate.
With respect to the technology or technical data the petitioner
will release or otherwise provide access to the 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.

2.

4.

Authorized Signatory's Title

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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

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
beneficiary AND the petitioner will prevent access to
the controlled technology or technical data by the
beneficiary until and unless the petitioner has
received the required license or other authorization to
release it to the beneficiary.

Part 7. Statement, Contact Information,
Declaration, and Signature of the Petitioner or
Authorized Signatory
NOTE: Read the Penalties section of the Form I-129S
Instructions before completing this part.

Petitioner's or Authorized Signatory's Statement

NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.
Petitioner's Statement Regarding the Interpreter
1.a.

I can read and understand English, and I have read
and understand every question and instruction on this
petition and my answer to every question.

1.b.

The interpreter named in Part 7. has read to me every
question and instruction on this petition, and my
answer to every question, in
,
a language in which I am fluent. I understand all of
this information as interpreted.

2.

3.b. Authorized Signatory's Given Name (First Name)

5.

Authorized Signatory's Daytime Telephone Number

6.

Authorized Signatory's Mobile Telephone Number (if any)

7.

Authorized Signatory's Email Address (if any)

Petitioner's or Authorized Signatory's Declaration
and Certification

Copies of any documents submitted are exact photocopies of
unaltered, original documents, and I understand that, as the
petitioner, I may be required to submit original documents to
USCIS at a later date. Photocopied, faxed, or scanned copies of
Form I-129S that I will submit to any other Federal agency,
including U.S. Department of State and U.S. Customs and
Border Protection (CBP), are exact copies of this unaltered,
original Form I-129S.
I authorize the release of any information from my records, or
from the petitioning organization's records, that USCIS needs to
determine eligibility for the immigration benefit sought or where
authorized by law. I recognize the authority of USCIS to conduct
audits of this petition using publicly available open source
information. I also recognize that any supporting evidence
submitted in support of this petition may be verified by USCIS
through any means determined appropriate by USCIS, including
but not limited to, on-site compliance reviews.
If filing this petition on behalf of an organization, I certify that I
am authorized to do so by the organization.
I certify, under penalty of perjury, that I have reviewed this
petition, I understand all of the information contained in, and
submitted with, my petition, and all of this information is
complete, true, and correct.

Petitioner's Statement Regarding the Preparer
At my request, the preparer named in Part 9.,
,
prepared this petition for me based only upon
information I provided or authorized.

Form I-129S 06/12/13 N

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Part 7. Statement, Contact Information,
Declaration, and Signature of the Petitioner or
Authorized Signatory (continued)
Petitioner's or Authorized Signatory's Signature

Interpreter's Contact Information
4.

Interpreter's Daytime Telephone Number

5.

Interpreter's Mobile Telephone Number (if any)

6.

Interpreter's Email Address (if any)

8.a. Petitioner's Signature

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8.b. Date of Signature (mm/dd/yyyy)

NOTE TO ALL PETITIONERS AND AUTHORIZED
SIGNATORIES: If you do not completely fill out this petition
or fail to submit required documents listed in the Instructions,
USCIS may delay a decision on or deny your petition.

Part 8. Interpreter's Contact Information,
Certification, and Signature

Provide the following information about the interpreter.

Interpreter's Full Name

1.a. Interpreter's Family Name (Last Name)

1.b. Interpreter's Given Name (First Name)

Interpreter's Certification

I certify that:

I am fluent in English and

,

which is the same language provided in Part 7., Item Number
1.b. and I have read to this petitioner or the authorized signatory
in the identified language every question and instruction on this
petition and his or her answer to every question. The petitioner
or authorized signatory informed me that he or she understands
every instruction, question, and answer on the petition,
including the Petitioner's or Authorized Signatory's
Declaration and Certification, and has verified the accuracy of
every answer.

Interpreter's Signature

7.a. Interpreter's Signature

2.

Interpreter's Business or Organization Name (if any)

7.b. Date of Signature (mm/dd/yyyy)

Interpreter's Mailing Address
3.a. Street Number
and Name
3.b.

Apt.

Ste.

Flr.

Provide the following information about the preparer.

3.c. City or Town
3.d. State

Part 9. Contact Information, Declaration, and
Signature of the Person Preparing this Petition, if
Other Than the Petitioner

3.e. ZIP Code

Preparer's Full Name
1.a. Preparer's Family Name (Last Name)

3.f.

Province

3.g. Postal Code

1.b. Preparer's Given Name (First Name)

3.h. Country
2.

Preparer's Business or Organization Name (if any)

NOTE: If applicable, provide the name of your accredited
organization recognized by the Board of Immigration Appeals
(BIA).

Form I-129S 06/12/13 N

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Part 9. Contact Information, Declaration, and
Signature of the Person Preparing this Petition, if
Other Than the Petitioner (continued)
Preparer's Mailing Address
3.a. Street Number
and Name
3.b.

Preparer's Certification
By my signature, I certify, under penalty of perjury, that I
prepared this petition at the request of the petitioner or
authorized signatory. The petitioner has reviewed this
completed petition, including the Petitioner's or Authorized
Signatory's Declaration and Certification, and informed me
that all of this information in the petition and in the supporting
documents is complete, true, and correct.

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Apt.

Ste.

Flr.

Preparer's Signature

3.c. City or Town
3.d. State
3.f.

8.a. Preparer's Signature

3.e. ZIP Code

Province

8.b. Date of Signature (mm/dd/yyyy)

3.g. Postal Code
3.h. Country

Preparer's Contact Information
4.

Preparer's Daytime Telephone Number

5.

Preparer's Mobile Telephone Number (if any)

6.

Preparer's Email Address (if any)

Preparer's Statement
7.a.

I am not an attorney or accredited representative but
have prepared this petition on behalf of the petitioner
and with the petitioner's consent.

7.b.

I am an attorney or accredited representative and my
representation of the petitioner in this case
extends
does not extend beyond the
preparation of this petition.
NOTE: If you are an attorney or accredited
representative whose representation extends beyond
preparation of this petition, you must submit a
completed Form G-28, Notice of Entry of
Appearance as Attorney or Accredited
Representative, or G-28I, Notice of Entry of
Appearance as Attorney In Matters Outside the
Geographical Confines of the United States, with this
petition.

Form I-129S 06/12/13 N

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5.a. Page Number

Part 10. Additional Information
If you need extra space to provide any additional information
within this petition, use the space below. If you need more
space than what is provided, you may make copies of this page
to complete and file with this petition or attach a separate sheet
of paper. Include the beneficiary's name and A-Number (if any)
at the top of each sheet; indicate the Page Number, Part
Number, and Item Number to which your answer refers; and
sign and date each sheet.

5.b. Part Number

5.c. Item Number

5.d.

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1.a. Beneficiary's Family Name (Last Name)

1.b. Beneficiary's Given Name (First Name)

1.c. Beneficiary's Middle Name

6.a. Page Number

2.

Beneficiary's A-Number (if any)
► A-

3.a. Page Number

3.d.

3.b. Part Number

6.b. Part Number

6.c. Item Number

7.b. Part Number

7.c. Item Number

6.d.

3.c. Item Number

7.a. Page Number

7.d.
4.a. Page Number

4.b. Part Number

4.c. Item Number

4.d.

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