Form I-129CW Petition for CNMI-Only Nonimmigrant Transition Worker

Form I-129CW, Petition for a CNMI-Only
Nonimmigrant Transitional Worker

USCIS
Form I-129CW

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

OMB No. 1615-0111
Expires 05/31/2020

For USCIS Use Only
Partial Approval (explain)

Receipt

Class:
# of Workers:
Job Code:
Priority Number:
Validity Dates: From:
To:

Action Block

Classification Approved

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Consulate/POE/PFI Notified

At:

Extension Granted

COS/Extension Granted

► START HERE - Type or print in black ink.

Part 1. Information about the Employer Filing
This Petition

Part 2. Information About This Petition

NOTE: See the Instructions for fee information.

Name of Representative for Employer/Organization

1.

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

Basis for Classification (Select only one box):

1.c. Middle Name

Name of Employer/Organization and Address
2.a. Name of Employer/Organization

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

2.d.

Apt.

2.a.

New employment (including a duplicate for U.S.
Department of State notification).

2.b.

Continuation of previously approved employment
without change with the same employer.

2.c.

Change in previously approved employment.

2.d.

New concurrent employment.

2.e.

Change of employer.

2.f.

Amended petition.

3.

2.c. Street Number
and Name
Ste.

Requested Nonimmigrant Classification

If you selected Item Number 2.b., 2.c., 2.d., 2.e., or 2.f.,
provide the petition receipt number.
►

Flr.
4.

2.e. City or Town
2.f.

State

2.g. ZIP Code

3.

Federal Employer Identification Number

4.

USCIS Online Account Number (if any)

Prior Petition. If the beneficiary is in the CNMI as a
nonimmigrant and is applying to change and/or extend his
or her status, provide the prior petition or application
receipt number.

(USPS ZIP Code Lookup)

►

Form I-129CW 08/01/18

Page 1 of 13

Part 2. Information About This Petition
(continued)

3.

Date of Birth (mm/dd/yyyy)

4.

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

Requested Action (Select only one box):
5.a.

Notify the office in Part 4. so the beneficiary can
obtain a visa or be admitted.

5.b.

Change the beneficiary's status and extend their stay
since the beneficiary is in the CNMI in another status
(see the Instructions for limitations). This option is
available only where you select "New Employment"
in Item Number 2.a., above. Select the appropriate
box indicating the type of status change.

5.

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

6.

Country of Birth

7.

Province of Birth

8.

Country of Citizenship or Nationality

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Initial Grant of CW-1 Status in CNMI

Change of Federal Nonimmigrant Status to
CW-1
5.c.
5.d.

6.

Extend the stay of the beneficiary since they now
hold this status.

Amend the stay of the beneficiary since they now
hold this status.

Total number of workers in petition (See instructions
relating to when more than one worker can be included):

If in the CNMI, complete the following:
9.

Date of Last Arrival (mm/dd/yyyy)

10.

Form I-94 Arrival-Departure Record Number
►

11.a. Current Nonimmigrant Status

►

11.b. Date Status Expires (mm/dd/yyyy)

Part 3. Information About the Beneficiaries For
Whom You Are Filing

Provide the requested information below. If you need
additional space to complete this section, use the space provided
in Part 9. Additional Information. If you need additional
space to name each beneficiary included in this petition use
Form I-129CW Classification Supplement.

Beneficiary's Full Name
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name

12.a. Passport Number

12.b. Country Where Passport Was Issued

12.c. Date Passport Issued (mm/dd/yyyy)
12.d. Date Passport Expires (mm/dd/yyyy)

Beneficiary's Current CNMI Address
13.a. Street Number
and Name
13.b.

Apt.

Other Names Used (if any)

13.c. City or Town

Provide all other names the beneficiary has ever used, including
aliases, maiden name, and nicknames. If you need extra space
to complete this section, use the space provided in Part 9.
Additional Information.

13.d. State

Ste.

Flr.

13.e. ZIP Code

2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)
2.c. Middle Name
Form I-129CW 08/01/18

Page 2 of 13

6.

Part 4. Processing Information
If the beneficiary named in Part 3. is outside the CNMI, or a
requested extension of stay, or change of status cannot be
granted, provide the U.S. Consulate or inspection facility you
want notified if this petition is approved.

Consulate

No
Is any beneficiary in this petition in removal proceedings?
Yes. If yes, explain in Part 10. Additional
Information.
No

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Port of Entry

►

Yes. If yes, how many?

7.

1.a. Type of Office (Select only one box):

Are applications by dependents being filed with this
petition?

8.

1.b. Office Address (City)

Have you ever filed an immigrant petition for any
beneficiary in this petition?
Yes. If yes, explain in Part 10. Additional
Information.
No

1.c. U.S. State or Foreign Country

If you indicated you were filing a new petition in Part 2., has
any beneficiary in this petition:

Beneficiary's Foreign Address
2.a. Street Number
and Name
2.b.

Apt.

Ste.

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

Flr.

2.e. ZIP Code

Province

2.h. Country

Ever been given the classification you are now
requesting?
Yes. If yes, explain in Part 10. Additional
Information.
No

10.

2.g. Postal Code

3.

9.

Ever been denied the classification you are now
requesting?
Yes. If yes, explain in Part 10. Additional
Information.
No

11.

Have you ever previously filed a petition for this
beneficiary?
Yes. If yes, explain in Part 10. Additional
Information.
No

Does each beneficiary in this petition have a valid passport?
Yes

4.

No. If no, type or print a brief explanation in Part
10. Additional Information.

Part 5. Basic Information About the Proposed
Employment and Employer

Not Required to Have Passport

NOTE: Attach Form I-129CW Classification Supplement for
each beneficiary you are petitioning for.

Are you filing any other petitions with this one?
Yes. If yes, how many?

►

1.

Job Title

2.

SOC Code

3.

Nontechnical Job Description

No
5.

Are applications for replacement/initial Form I-94's being
filed with this petition?
Yes. If yes, how many?

►

-

►

No

Form I-129CW 08/01/18

Page 3 of 13

Part 5. Basic Information About the Proposed
Employment and Employer (continued)

Part 6. Information about the Proposed
Employee's (Primary Beneficiary) Public Benefits

Address where the beneficiary will work if different from
address in Part 1.

1.

4.a. Street Number
and Name
4.b.

Apt.

Ste.

4.c. City or Town
4.d. State
5.

Has the beneficiary EVER applied for or received any
public benefits as listed in the instructions?
Yes
No
If you answered “Yes,” provide information about the
public benefits in the section below. If you need
additional space to complete any Item Number in this
Part, use the space provided in Part 10. Additional
Information.

Flr.

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4.e. ZIP Code

1.a. Type of Benefit

Is this a full-time position?

Yes - Wages per week or per year:

1.b. Amount of Benefit

$

$

Weekly

No - Hours per week:
6.

Other Compensation (Explain)

Monthly

Annually

Other

1.c. Agency That Granted The Benefit

1.d. Date Benefit Was Granted (mm/dd/yyyy)

Dates of Intended Employment

1.e. Date Benefit Ended or Expires (mm/dd/yyyy)

7.a. Date From (mm/dd/yyyy)

1.f.

Number of Household Members Receiving the Benefit

7.b. Date To (mm/dd/yyyy)
8.

Type of Petitioner (Select only one box):
Business

2.a. Type of Benefit

Organization
Other (Type or print a brief explanation in Part 10.
Additional Information.)

2.b. Amount of Benefit
Weekly

Monthly

$
Annually

9.

Type of Business

10.

Year Established

2.c. Agency That Granted The Benefit

11.

Current Number of Employees

2.d. Date Benefit Was Granted (mm/dd/yyyy)

12.

Gross Annual Income

2.e. Date Benefit Ended or Expires (mm/dd/yyyy)

13.

Net Annual Income

2.f.

Form I-129CW 08/01/18

Other

Number of Household Members Receiving the Benefit

Page 4 of 13

Part 6. Information about the Proposed
Employee's (Primary Beneficiary) Public Benefits
(continued)
3.a. Type of Benefit

NOTE: Read the Penalties section of the Form I-129CW
Instructions before completing this part. You, the petitioner,
must file Form I-129CW while in the United States.

3.b. Amount of Benefit
Weekly
Other

Part 7. Statement, Contact Information,
Declaration, Certification, and Signature of the
Petitioner or Authorized Signatory

$

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Monthly

Annually

3.c. Agency That Granted The Benefit

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.
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 8. has read to me every
question and instruction on this petition and my
answer to every question in

3.d. Date Benefit Was Granted (mm/dd/yyyy)

3.e. Date Benefit Ended or Expires (mm/dd/yyyy)

3.f.

a language in which I am fluent. I understood all of
this information as interpreted.

Number of Household Members Receiving the Benefit

2.

4.a. Does the beneficiary anticipate applying for or receiving
the public benefits, as listed in the instructions, in the
future in the United States?
Yes
No
4.b. Provide information you believe is relevant that would
explain why you or any derivative listed on this
application anticipate applying for or receiving public
benefits in the future. If you need additional space, you
may use Part 10. Additional Information.

,

At my request, the preparer named in Part 9.,
,

prepared this petition for me based only upon
information I provided or authorized.

Petitioner's or Authorized Signatory's Contact
Information

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

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

Form I-129CW 08/01/18

4.

Authorized Signatory's Title

5.

Authorized Signatory's Daytime Telephone Number

6.

Authorized Signatory's Mobile Telephone Number (if any)

7.

Authorized Signatory's Email Address (if any)

Page 5 of 13

Petitioner's or Authorized Signatory's Declaration
and Certification

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

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.

Provide the following information about the interpreter.

I authorize the release of any information from my records, or
from the petitioning organization's records, to USCIS or other
entities and persons where necessary 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.

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

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If filing this petition on behalf of an organization, I certify that I
am authorized to do so by the organization.
I understand that USCIS may require me to appear for an
appointment to take my biometrics (fingerprints, photograph,
and/or signature) and, at that time, if I am required to provide
biometrics, I will be required to sign an oath reaffirming that:

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

2.

Interpreter's Business or Organization Name (if any)

Interpreter's Mailing Address

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

Apt.

Flr.

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

1) I reviewed and understood all of the information
contained in, and submitted with, my petition; and

3.f.

2) All of this information was complete, true, and correct
at the time of filing.

3.g. Postal Code

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.

Ste.

3.e. ZIP Code

Province

3.h. Country

Interpreter's Contact Information

4.

Interpreter's Daytime Telephone Number

5.

Interpreter's Mobile Telephone Number (if any)

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

6.

Interpreter's Email Address (if any)

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.

Interpreter's Certification

Petitioner's or Authorized Signatory's Signature
8.a. Petitioner's Signature

I certify, under penalty of perjury, that:
I am fluent in English and

,

which is the same language specified in Part 6., 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.
Form I-129CW 08/01/18

Page 6 of 13

Part 9. Contact Information, Declaration, and
Signature of the Person Preparing This Petition,
if Other Than the Petitioner (continued)

Interpreter's Signature
7.a. Interpreter's Signature

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

Preparer's Statement
7.a.

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

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

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Provide the following information about the preparer.

Preparer's Full Name

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

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, you may need to submit a completed
Form G-28, Notice of Entry of Appearance as
Attorney or Accredited Representative, with this
petition.

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

Preparer's Certification

2.

Preparer's Business or Organization Name (if any)

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

Apt.

Ste.

Preparer's Signature

8.a. Preparer's Signature

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

Flr.

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 form and in the supporting
documents is complete, true, and correct.

3.e. ZIP Code

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

3.f.

Province

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)

Form I-129CW 08/01/18

Page 7 of 13

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. Type or print your 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.

1.c. Middle Name

5.c. Item Number

5.d.

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

2.

5.b. Part Number

A-Number (if any) ► A-

3.a. Page Number

3.b. Part Number

3.d.

4.a. Page Number

3.c. Item Number

6.a. Page Number

6.b. Part Number

6.c. Item Number

7.b. Part Number

7.c. Item Number

6.d.

4.b. Part Number

4.d.

Form I-129CW 08/01/18

4.c. Item Number

7.a. Page Number

7.d.

Page 8 of 13

Part 11. Accommodations for Individuals With
Disabilities and/or Impairments
NOTE: Read the information in the Form I-129CW
Instructions before completing this part.
1.

Name of Employer or Organization Filing Petition:

The beneficiary, if present in the CNMI, is lawfully present in
the CNMI.
The position is not temporary or seasonal employment, and the
above named petitioning employer does not reasonably believe
the position to qualify for any other nonimmigrant worker
classification.
The position falls within the list of occupational categories
designated by the Secretary at 8 CFR 214.2(w)(1)(ix).

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2.

Name of Person for Whom You Are Filing:

3.

Are you, the petitioning employer, requesting an
accommodation because of the beneficiary's disabilities
and/or impairments?

Select only one box:
1.a.

Professional, Technical, or Management Occupations

1.b.

Clerical and Sales Occupations

1.c.

Service Occupations

1.d.

If you answered “Yes” to Item Number 3., select any
applicable in Item Numbers 4.a. - 4.c. and provide an answer.

Agricultural, Fisheries, Forestry, and Related
Occupations

1.e.

Processing Occupations

4.a.

1.f.

Machine Trade Occupations

1.g.

Benchwork Occupations

1.h.

Structural Occupations

1.i.

Miscellaneous Occupations

Yes

No

The beneficiary is deaf or hard of hearing and
requests the following accommodation. (If they are
requesting a sign-language interpreter, indicate for
which language (for example, American Sign
Language).)

4.b.

The beneficiary is blind or has low vision and
requests the following accommodation:

4.c.

The beneficiary has another type of disability and/or
impairment. (Describe the nature of their disability
and/or impairment and the accommodation you are
requesting.)

I certify under penalty of perjury, under the laws of the United
States of America, that the contents of this attestation and the
evidence submitted with it are true and correct to the best of my
knowledge. If filing on behalf of an organization, I certify that I
am empowered to do so by the organization. If this petition is
to extend a prior petition, I certify that the proposed
employment is under the same terms and conditions as stated in
the prior approved petition. I authorize the release of any
information from my records, or from the petitioning
organization's record that U.S. Citizenship and Immigration
Services needs to determine eligibility for the benefit sought.
2.

Petitioner's Printed Name

3.

Title

4.

Employer/Organization Name

Part 12. Employer Attestation
Employer Attestation
There are no qualified U.S. workers available to fill the position
offered by the above named petitioning employer.
The above named petitioning employer is doing business as
defined in the regulations at 8 CFR 214.2(w)(1)(ii).
The above named petitioning employer is a legitimate business
as defined in the regulations at 8 CFR 214.2(w)(1)(vi).
The above named petitioning employer is an eligible employer
as described in 8 CFR 214.2(w)(4) and will continue to comply
with the requirements for an eligible employer until such time
as the employer no longer employs any CW-1 nonimmigrant
worker.
The beneficiary meets the qualifications for the position.

Form I-129CW 08/01/18

Page 9 of 13

Part 12. Employer Attestation (continued)
Employer/Organization's Physical Address
5.a. Street Number
and Name
5.b.

Apt.

Ste.

5.c. City or Town
5.d. State

Flr.

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5.e. ZIP Code

Employer/Organization's Contact Information
6.

Daytime Telephone Number

7.

Fax Number (if any)

8.

Email Address (if any)

Petitioner's Signature
9.a. Petitioner's Signature

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

Form I-129CW 08/01/18

Page 10 of 13

Form I-129CW Classification Supplement

USCIS
Form I-129CW

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

Attach to Form I-129CW when more than one beneficiary is
included in the petition. (Provide each beneficiary separately.
Do not include the person you named on Form I-129CW.)

Part 1. Information About the Additional
Beneficiary (if applicable)

OMB No. 1615-0111
Expires 05/31/2020

IF IN THE CNMI
9.

Date of Last Arrival (mm/dd/yyyy)

10.

Form I-94 Arrival-Departure Record Number
►

11.a. Current Nonimmigrant Status

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

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11.b. Date Status Expires (mm/dd/yyyy)

1.c. Middle Name

12.a. Passport Number

2.

Date of Birth (mm/dd/yyyy)

3.

U.S. Social Security Number (if any)

12.b. Country Where Passport Issued

►

4.

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

12.c. Date Passport Issued (mm/dd/yyyy)

12.d. Date Passport Expires (mm/dd/yyyy)

Beneficiary's Current CNMI Address
5.a. Street Number
and Name
5.b.

Apt.

Ste.

Flr.

Part 2. Information about the Proposed
Beneficiary's (Spouse or Child) Public Benefits

1.

5.c. City or Town
5.d. State

6.a. Street Number
and Name
Apt.

Ste.

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

Yes

5.e. ZIP Code

Beneficiary's Foreign Address

6.b.

Has the beneficiary EVER applied for or received any
public benefits as listed in the instructions?

Flr.

6.e. ZIP Code

Province

No

If you answered “Yes,” provide information about the public
benefits in the section below. If you need additional space to
complete any Item Number in this Part, use the space provided
in Part 10. Additional Information.
1.a. Type of Benefit

1.b. Amount of Benefit
Weekly

Monthly

$
Annually

Other
6.g. Postal Code
1.c. Agency That Granted The Benefit
6.h. Country
1.d. Date Benefit Was Granted (or tax year) (mm/dd/yyyy)
7.

Country of Birth

8.

Country of Citizenship or Nationality

Form I-129CW 08/01/18

1.e. Date Benefit Ended or Expires (mm/dd/yyyy)
(or tax year)

Page 11 of 13

Part 2. Information about the Proposed
Beneficiary's (Spouse or Child) Public Benefits
(continued)

Part 3. Accommodations for Individuals With
Disabilities and/or Impairments

2.a. Type of Benefit

NOTE: Read the information in the Form I-129CW
Instructions before completing this part.
1.

2.b. Amount of Benefit
Weekly
Other

Name of Employer or Organization Filing Petition

$

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Monthly

Annually

2.c. Agency That Granted The Benefit

2.

Name of Person For Whom You Are Filing

3.

Are you, the petitioning employer, requesting an
accommodation because of the beneficiary's disabilities
and/or impairments?
Yes
No

2.d. Date Benefit Was Granted (or tax year) (mm/dd/yyyy)

If you answered “Yes” to Item Number 3., select any applicable
box in Item Numbers 4.a. - 4.c. and provide an answer.

2.e. Date Benefit Ended or Expires (mm/dd/yyyy)
(or tax year)

4.a.

The beneficiary is deaf or hard of hearing and requests
the following accommodation. (If they are requesting
a sign-language interpreter, indicate for which
language (for example, American Sign Language).)

4.b.

The beneficiary is blind or has low vision and
requests the following accommodation:

4.c.

The beneficiary has another type of disability and/or
impairment. (Describe the nature of their disability
and/or impairment and the accommodation you are
requesting.)

3.a. Type of Benefit

3.b. Amount of Benefit
Weekly
Other

Monthly

$

Annually

3.c. Agency That Granted The Benefit

3.d. Date Benefit Was Granted (or tax year) (mm/dd/yyyy)

Part 4. Employer Attestation

3.e. Date Benefit Ended or Expires (mm/dd/yyyy)
(or tax year)
4.a. Does the beneficiary anticipate applying for or receiving
the public benefits, as listed in the instructions, in the
future in the United States?
Yes
No
4.b. Provide information you believe is relevant that would
explain why you anticipate or do not anticipate applying
for or receiving public benefits in the future. If you need
additional space, you may use Part 10. Additional
Information.

Employer Attestation
There are no qualified U.S. workers available to fill the position
offered by the above named petitioning employer.
The above named petitioning employer is doing business as
defined in the regulations at 8 CFR 214.2(w)(1)(ii).
The above named petitioning employer is a legitimate business
as defined in the regulations at 8 CFR 214.2(w)(1)(vi).
The above named petitioning employer is an eligible employer
as described in 8 CFR 214.2(w)(4) and will continue to comply
with the requirements for an eligible employer until such time
as the employer no longer employs any CW-1 nonimmigrant
worker.
The beneficiary meets the qualifications for the position.
The beneficiary, if present in the CNMI, is lawfully present in
the CNMI.

Form I-129CW 08/01/18

Page 12 of 13

Part 4. Employer Attestation (continued)

Employer/Organization's Contact Information

The position is not temporary or seasonal employment, and the
above named petitioning employer does not reasonably believe
the position to qualify for any other nonimmigrant worker
classification.

6.

Daytime Telephone Number

7.

Fax Number (if any)

8.

Email Address (if any)

The position falls within the list of occupational categories
designated by the Secretary at 8 CFR 214.2(w)(1)(ix).

DRAFT
Not for
Production
09/27/2018

Select only one box:
1.a.

Professional, Technical, or Management Occupations

1.b.

Clerical and Sales Occupations

Petitioner's Signature

1.c.

Service Occupations

9.a. Petitioner's Signature

1.d.

Agricultural, Fisheries, Forestry, and Related
Occupations

1.e.

Processing Occupations

1.f.

Machine Trade Occupations

1.g.

Benchwork Occupations

1.h.

Structural Occupations

1.i.

Miscellaneous Occupations

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

I certify under penalty of perjury, under the laws of the United
States of America, that the contents of this attestation and the
evidence submitted with it are true and correct to the best of my
knowledge. If filing on behalf of an organization, I certify that I
am empowered to do so by the organization. If this petition is
to extend a prior petition, I certify that the proposed
employment is under the same terms and conditions as stated in
the prior approved petition. I authorize the release of any
information from my records, or from the petitioning
organization's record that U.S. Citizenship and Immigration
Services needs to determine eligibility for the benefit sought.
2.

Petitioner's Printed Name

3.

Title

4.

Employer/Organization Name

Employer/Organization's Physical Address
5.a. Street Number
and Name
5.b.

Apt.

Ste.

Flr.

5.c. City or Town
5.d. State

5.e. ZIP Code

Form I-129CW 08/01/18

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