Form I-129H2B Petition for a Nonimmigrant Worker: H-2B Classifications

Petition for Nonimmigrant Worker:
H-2B Classification

USCIS
Form I-129H2B

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

OMB No. 1615-xxxx
Expires xx/xx/20xx

► START HERE - Type or print in black ink.

Part 1. Petitioner Information
If you are an individual or sole proprietor filing this petition, complete Item Numbers 1. - 2. If you are a company or an organization
filing this petition, complete Item Number 3. All petitioners should fill out Item Numbers 4. - 14., as applicable.
1.

Legal Name of Petitioning Individual or Sole Proprietor

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Family Name (Last Name)

Given Name (First Name)

2.

Date of Birth (mm/dd/yyyy)

3.

Petitioning Company or Organization Name

4.

Trade Name or “Doing Business As” Name (if applicable)

5.

Primary U.S. Office Address of Petitioner

6.

Middle Name (if applicable)

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

ZIP Code

(USPS ZIP Code Lookup)

Yes

Is your mailing address different from your Primary U.S. Office Address?

No

If you answered “Yes” to Item Number 6., provide your mailing address below.
7.

Mailing Address

In Care Of Name (if any)

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province or Region

Postal Code

ZIP Code

(USPS ZIP Code Lookup)

Country

Petitioner's Contact Information
8.

U.S. Daytime Telephone Number

10.

Email Address (if any)

Form I-129H2B xx/xx/19

9.

U.S. Mobile Telephone Number (if any)

Page 1 of 19

Part 1. Petitioner Information (continued)
Tax Payer Identification Numbers
Provide the following information, as applicable.
11.

Employer Identification Number (EIN)

12.

►
13.

Individual Taxpayer Identification Number (ITIN)
►

U.S. Social Security Number (if any)

14.

USCIS Online Account Number (if any)
►

►

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E-Verify Information
15.

Are you a participant in the E-Verify program?

Yes

No

If you answered “Yes” to Item Number 15., provide the information requested in Item Numbers 16.A. - B.
16.

A.

Employer's Name as Listed in E-Verify

B.

Employer's E-Verify Company Identification Number or an E-Verify Client Company Identification Number

Part 2. Information About This Petition (See Instructions for fee information.)
1.

Basis for Classification (select only one box)
A.

New employment.

B.

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

C.

Change in previously approved employment (provide an explanation in Part 10. Additional Information).

D.

New concurrent employment.

E.

Change of employer for a beneficiary already in the requested classification.

F.

Amended petition (provide an explanation in Part 10. Additional Information).

2.

If you selected Item F. Amended petition in Item Number 1., provide the receipt number of the petition you seek to amend.
►

3.

Requested Action (select only one box)

4.

A.

Notify the office in Part 4. so that the beneficiary can apply for and obtain a visa or be admitted, if eligible.

B.

Change the status and extend the stay of each beneficiary because the beneficiary(ies) is/are now in the United States
in another status (see the Instructions for limitations). This is available only when you select A. New Employment in
Item Number 1. above.

C.

Extend the stay of each beneficiary because the beneficiary(ies) now hold(s) this status.

D.

Amend the stay of each beneficiary because the beneficiary(ies) now hold(s) this status.

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

Form I-129H2B xx/xx/19

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Part 3. Beneficiary's Information
Indicate the type of beneficiaries you are requesting in this petition, and list the countries of citizenship for these beneficiaries.
1.

Type of beneficiaries requested (select only one box)
Named Workers

2.

Unnamed Workers

List the countries of citizenship for the workers you are requesting.
Country of Citizenship

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If requesting unnamed workers in Item Number 1., proceed to Part 4. Processing Information. However, you must provide the
name and all of the information requested below for each H-2B worker who is in the United States or who is not from a country that
has been designated as a participating country in accordance with 8 CFR 214.2(h)(6)(i)(E)(1). See www.uscis.gov/h-2b for the list of
participating countries. If you are providing information for more than one named beneficiary, complete a separate copy of the
Named Worker Attachment for Form I-129H2B for each additional beneficiary included in this petition.
3.

Is each H-2B worker you plan to hire from a country designated as a participating country in
accordance with 8 CFR 214.2(h)(6)(i)(E)(1)? (See www.uscis.gov/h-2b for the list of H-2B
participating countries.)

Yes

No

If you answered “No” to Item Number 3., you must provide the information requested in Item Number 4.
4.

List each H-2B worker from a non-participating country. If you need more space, use Part 10. Additional Information or
attach an additional sheet of paper.
Family Name (Last Name)

Given Name (First Name)

Middle Name

NOTE: If any of the H-2B workers you are requesting are nationals of a country that is not designated as a participating country,
you must also provide evidence showing: (1) that workers with the required skills are not available among foreign workers from
countries currently on the eligible countries list; (2) whether the beneficiaries have been admitted previously to the United States
in H-2B status; (3) that there is no potential for abuse, fraud, or other harm to the integrity of the H-2B visa programs through the
potential admission of the intended workers; and (4) any other factors that may serve the United States interest.

Information About the Beneficiary
5.

Beneficiary's Full Name
Family Name (Last Name)

6.

Given Name (First Name)

Middle Name

Provide all other names the beneficiary has used. Include nicknames, 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.
Family Name (Last Name)

Form I-129H2B xx/xx/19

Given Name (First Name)

Middle Name

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Part 3. Beneficiary's Information (continued)
Other Information
7.

8.

Date of Birth (mm/dd/yyyy)

Gender

9.

Male
10.

Alien Registration Number (A-Number)
►

11.

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

Female

USCIS Online Account Number (if any)
►

A-

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12.

City or Town of Birth

13.

Province of Birth

14.

Country of Birth

15.

Country of Citizenship or Nationality

16.

Beneficiary's Foreign Address
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

17.

Postal Code

ZIP Code

Country

If the beneficiary is in the United States, complete the following:
Date of Last Arrival (mm/dd/yyyy)

Form I-94 Arrival-Departure Record Number (if any)
►

Passport or Travel Document Number

Date Passport or Travel Document Issued (mm/dd/yyyy)

Date Passport or Travel Document Expires (mm/dd/yyyy)

Passport or Travel Document Country of Issuance

Current Nonimmigrant
Status

Date Status Expires (mm/dd/yyyy) or Duration of Status (D/S)
(see Form I-94 Arrival/Departure Document)

Student and Exchange Visitor Information System (SEVIS)
Number (if any)

18.

Employment Authorization Document (EAD)
Number (if any)

Does the beneficiary have a U.S. residential address?

Yes

No

If you answered “Yes” to Item Number 18., you must provide the beneficiary's U.S. residential address information in Item
Number 19.
19.

Beneficiary's Current U.S. Residential Address (Do not list a P.O. Box unless the beneficiary resides in the Commonwealth of
the Northern Mariana Islands (CNMI).)
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Form I-129H2B xx/xx/19

ZIP Code

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Part 3. Beneficiary's Information (continued)
20.

Provide the most recent petition/application receipt number for the beneficiary. If none exists, indicate "None."
►

21.

Have you ever filed an immigrant petition for this beneficiary?

Yes

No

Yes

No

Yes

No

If you answered “Yes” to Item Number 21., identify the classification sought and the receipt numbers
for those petitions in Part 10. Additional Information.
22.

Have you ever filed a nonimmigrant petition for this beneficiary?

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If you answered “Yes” to Item Number 22., identify the classification sought and the receipt numbers
for those petitions in Part 10. Additional Information.
23.

Has this beneficiary ever been denied H-2B classification on any prior petition you filed on behalf of
this beneficiary?

If you answered “Yes” to Item Number 23., identify the classification sought and the receipt numbers
for those petitions in Part 10. Additional Information.
24.

List the beneficiary's prior periods of stay in H or L classification in the United States for the last three years. Be sure to only
list those periods in which the beneficiary was actually in the United States in an H or L classification. Do not include periods
in which the beneficiary was in a dependent status, for example, H-4 or L-2 status. If you need more space, use Part 10.
Additional Information or attach an additional sheet of paper.
Period of Stay
From (mm/dd/yyyy) To (mm/dd/yyyy)

Employer's Name

25.

Has this beneficiary experienced an interrupted stay associated with their entry in H or L classification?
(See form Instructions for more information on interrupted stays.)

Yes

No

If you answered “Yes” to Item Number 25., identify the classification sought and the receipt numbers for
those petitions in Part 10. Additional Information.

Part 4. Processing Information
1.

If any of the beneficiaries in Part 3. or in any Named Worker Attachment are outside the United States, or if a requested
extension of stay or change of status cannot be granted, indicate the U.S. Consulate or CBP inspection facility you want notified
if this petition is approved.
A.

Type of Office (select only one box)
U.S. Consulate

B.

CBP Pre-flight Inspection Facility

City Where Office is Located

Form I-129H2B xx/xx/19

C.

U.S. Port of Entry
U.S. State or Foreign Country

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Part 4. Processing Information (continued)
2.

Does each beneficiary in this petition have a valid passport?

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

If you answered “No” to Item Number 2., provide an explanation in Part 10. Additional
Information.
3.

Are you filing any other petitions with this one?
If you answered “Yes” to Item Number 3., how many? ►

4.

Have you previously filed any other petitions based on the same temporary labor
certification as this petition?

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If you answered “Yes” to Item Number 4., provide the previous receipt number(s). ►
5.

Are you filing any applications for dependents with this petition?
If you answered “Yes” to Item Number 5., how many? ►

6.

Is any beneficiary in this petition in removal proceedings?

If you answered “Yes” to Item Number 6., list the beneficiary's(ies) name(s) in Part 10.
Additional Information.
7.

Has any beneficiary in this petition ever been a J-1 exchange visitor or J-2 dependent of a J-1
exchange visitor?

8.

If you answered “Yes” to Item Number 7., provide the dates the beneficiary(ies) maintained status as a J-1 exchange visitor or J-2
dependent. Also, provide evidence of this status by attaching a copy of either a DS-2019, Certificate of Eligibility for Exchange
Visitor (J-1) Status, a Form IAP-66, or a copy of the passport that includes the J visa stamp. Additionally, if applicable, provide
evidence that the beneficiary(ies) fulfilled the two-year foreign residence requirement or had such residence requirement waived.

9.

Are you requesting substitution of beneficiaries who were approved and/or admitted based on
a prior H-2B petition?

Yes

No

Yes

No

If you answered “Yes” to Item Number 9., provide an explanation in Item Number 10.
10.

Explanation

11.

Does any beneficiary in this petition have ownership interest in the petitioning organization?
If you answered “Yes” to Item Number 11., provide an explanation of the beneficiary's(ies')
ownership interests in Item Number 12.

12.

Explanation

Form I-129H2B xx/xx/19

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Part 4. Processing Information (continued)
13.

Are you or the employer currently debarred by the U.S. Department of Labor (DOL)?

Yes

No

14.

Has the temporary labor certification supporting this petition been revoked by DOL?

Yes

No

15.

To the best of your knowledge, have you or the employer ever received a final order of debarment
from DOL in any foreign labor certification program?

Yes

No

16.

If you answered “Yes” to Item Numbers 13., 14., and/or 15., provide an explanation. If you need more space, use Part 10.
Additional Information or attach an additional sheet of paper.

17.

Is this petition exempt from the H-2B numerical limit (or cap)?

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Yes

No

If you answered “Yes” to Item Number 17., provide a response to Item Number 18.
18.

The basis for cap exemption is:
A.

I am requesting an extension of stay or amendment of stay for the beneficiary(ies) who currently holds H-2B status.

B.

The beneficiary(ies) will work as fish roe processors, fish roe technicians, or supervisors of fish roe processing.

C.

The beneficiary(ies) will work exclusively on Guam.

D.

The beneficiary(ies) will work exclusively in the Commonwealth of the Northern Mariana Islands (CNMI).

E.

The beneficiary(ies) has been previously counted against the H-2B cap in the same fiscal year. Provide receipt number.
►

F.

Other reason not identified above. Provide an explanation.

19.

Are you requesting consideration of this petition under the National Defense Authorization Act (NDAA)
exemption from the requirement that the services or labor be temporary because it is directly connected
to, or directly associated with, the military realignment on Guam or in the CNMI?

Yes

No

20.

Are you requesting consideration of this petition under the NDAA exemption from the requirement
that the services or labor be temporary because it is for health care workers on Guam or in the CNMI?

Yes

No

Part 5. Basic Information About the Proposed Employment and Employer
1.

Job Title

2.

Temporary Labor Certification ETA Case Number

3.

The nature of your need for the services or labor is: (select only one box)
A.

Seasonal

C.

Intermittent

B.

Peakload

D.

One-time occurrence

Form I-129H2B xx/xx/19

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Part 5. Basic Information About the Proposed Employment and Employer (continued)
4.

If you indicated your need is Seasonal in Item Number 3., is your need for additional worker(s) to
perform services or labor traditionally tied to a season of the year by an event or pattern, and of a
recurring nature?

Yes

No

If you answered “Yes” to Item Number 4., explain the basis on which the need recurs and specify the period(s) of time during
each year in which you do not need the services or labor.

5.

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If you indicated your need is Item B. Peakload in Item Number 3., do you regularly employ
permanent workers to perform the services or labor at the place of employment?

Yes

No

If you answered “Yes” to Item Number 5., explain why you need to supplement your permanent staff at the place of
employment on a temporary basis due to a seasonal or short-term demand, and why the temporary additional workers you are
seeking will not become a part of your regular operation.

6.

If you indicated your need is Intermittent in Item Number 3., have you employed permanent or full-time
workers to perform the services or labor.

Yes

No

If you answered “Yes” to Item Number 6., explain why you occasionally or intermittently need temporary workers to perform
services or labor for short periods and why you have not employed permanent or full-time workers to perform the services or
labor.

7.

If you indicated your need is a One-Time Occurrence in Item Number 3., provide a response to Item Number 7.A. or 7.B., as
applicable.
A.

Explain why you have not employed workers to perform the services or labor in the past and why you will not need
workers to perform the services or labor in the future.

OR
B.

8.

Explain the temporary event of short duration that has created your one-time need, even though the need for the services
or labor is otherwise permanent.

Will the beneficiary(ies) be working at multiple worksites?

Yes

No

If you answered "Yes" to Item Number 8., you must submit a detailed itinerary with the dates and
locations where the services or labor is to be performed.

Form I-129H2B xx/xx/19

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Part 5. Basic Information About the Proposed Employment and Employer (continued)
9.

If you answered “No” to Item Number 8., provide the address where the beneficiary(ies) will work if different from the address
in Part 1. Provide the name of the person or organization associated with the address, if different from the individual employer,
sole proprietor, or company or organization name listed in Part 1.
Legal Name of Petitioning Individual or Sole Proprietor
Family Name (Last Name)

Given Name (First Name)

Middle Name (if applicable)

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

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ZIP Code

10.

Will the beneficiary(ies) work for you off-site at another company or organization's location?

Yes

No

11.

Have you or a corporate parent, subsidiary, or affiliate filed an application for permanent labor
certification for this same position?

Yes

No

12.

Is this a full-time position?

Yes

No

13.

If you answered “No” to Item Number 12., how many hours per week for the position? ►

14.

Wages (in U.S. dollars)

15.

Other Compensation (Explain)

16.

Dates of Intended Employment
From (mm/dd/yyyy)

$

per (Specify hour, week, month, or year)

To (mm/dd/yyyy)

17.

Type of Business

19.

Current Number of Employees in the United States ►

20.

Gross Annual Income
$

Form I-129H2B xx/xx/19

18.

21.

Year Established

Net Annual Income
$

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Part 6. Petitioner and Employer Obligations
1.

Did you or do you plan to use a staffing, recruiting, or similar placement service or agent to locate the
H-2B workers that you intend to hire by filing this petition?

Yes

No

Yes

No

If you answered “Yes” to Item Number 1., provide the name and address of the service or agent used
in Item Numbers 2. and 3. If you need to include the name and address of more than one service or
agent, use the space provided in Part 10. Additional Information.
2.

Name of Service or Agent

3.

Address of Service or Agent

Apt. Ste. Flr. Number

City or Town

State

Province

4.

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Street Number and Name

Postal Code

ZIP Code

Country

Did any of the H-2B workers that you are requesting pay you, or an agent, a job placement fee or other
form of compensation (either direct or indirect) as a condition of the employment, or do they have an
agreement to pay you or the service such fees at a later date?

NOTE: The phrase "fee or other form of compensation" includes, but is not limited to, petition fees, attorney fees, recruitment
costs, and any other fees that are a condition of a beneficiary's employment that the employer is prohibited from passing to the
H-2B worker under law. This phrase does not include reasonable travel expenses and certain government-mandated fees (such
as passport fees) that are not prohibited from being passed to the H-2B worker by statute, regulations, or any laws.
5.

If you answered "Yes" to Item Number 4., list the types and amounts of fees that the worker(s) paid or
have agreed to pay.

Yes

No

6.

If the workers paid any fee or compensation, were they reimbursed?

Yes

No

7.

If the workers agreed to pay a fee, was that agreement terminated before the workers paid the fee?
(Submit evidence of termination or reimbursement with this petition.)

Yes

No

8.

Have you made inquiries to determine that the recruiter, facilitator, agent, or similar employment
service that you used has not collected, and will not collect, directly or indirectly, any fees or other
compensation from the H-2B workers requested in this petition as a condition of the H-2B
workers' employment?

Yes

No

Yes

No

NOTE: If USCIS determines that you knew, or should have known, that the workers requested in
connection with this petition paid any fees or other compensation at any time as a condition of
employment, your petition may be denied or revoked.
9.

Have you ever had an H-2B petition denied or revoked because an employee paid a job placement
fee or other similar compensation as a condition of the job offer or employment?

10.

If you answered “Yes” to Item Number 9., when?

Form I-129H2B xx/xx/19

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Part 6. Petitioner and Employer Obligations (continued)
11.

Receipt Number of denied or revoked H-2B petition:
►

12.

Describe the types and amounts of fees the workers paid or agreed to pay.

13.

Were the workers reimbursed for such fees and compensation?

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Yes

No

If you answered “Yes” to Item Number 13., submit evidence of reimbursement. If you answered “No” to Item Number 13.,
because you were unable to locate the workers, include evidence of your efforts to locate the workers.
14.

The H-2B petitioner and each employer consent to allow Government access to the site where the labor is being performed for
the purpose of determining compliance with H-2B requirements. The petitioner further agrees to notify DHS within 2 workdays
if:
A.

An H-2B worker fails to report for work within 5 workdays after the employment start date stated on the petition;

B.

The agricultural labor or services for which H-2B workers were hired is completed more than 30 days early;

C.

The H-2B worker absconds from the worksite by failing to report for work for 5 consecutive workdays without the
consent of the employer; or

D.

The H-2B worker is terminated prior to the completion of labor or services for which he or she was hired.

See www.uscis.gov/h-2b for the appropriate manner of notifying DHS as specified in a notice published in the Federal Register.
NOTE: "Workday" means the period between the time on any particular day when such employee commences his or her
principal activity and the time on that day at which he or she ceases such principal activity or activities.
15.

The petitioner agrees to retain evidence of such notification and make it available for inspection by
DHS officers for a one-year period.

Yes

No

Petitioner's or Employer's Agreement

The petitioner must complete and sign the statement in Item Number 16. If the petitioner is the employer's agent, the employer must
complete and sign the statement in Item Number 17.
16.

Petitioner

By filing this petition, I agree to the conditions of H-2B employment and agree to the notification requirements.
Signature of Petitioner

Date (mm/dd/yyyy)

Name of Petitioner

17.

Employer Who is Not the Petitioner
I certify that I have authorized the party filing this petition to act as my agent in this regard. I assume full responsibility for all
representations made by this agent on my behalf and agree to the conditions of H-2B eligibility.
Signature of Employer

Date (mm/dd/yyyy)

Name of Employer

Form I-129H2B xx/xx/19

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Part 7. Statement, Contact Information, Certification, and Signature of the Petitioner or Authorized
Signatory
NOTE: Read the Penalties section of the Form I-129H2B Instructions before completing this section.

Petitioner's or Authorized Signatory's Statement
NOTE: Select the box for either Item A. or B. in Item Number 1. If applicable, select the box for Item Number 2.
1.

Petitioner's or Authorized Signatory's Statement Regarding the Interpreter
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.

B.

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

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every question in

, a language in which I am fluent, and I

understood all of this information as interpreted.
2.

Petitioner's or Authorized Signatory'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.

Authorized Signatory's Contact Information
3.

Authorized Signatory's Family Name (Last Name)

Authorized Signatory's Given Name (First Name)

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)

Petitioner's or Authorized Signatory's Certification

Copies of any documents submitted are exact photocopies of unaltered, original documents, and I understand that, as the petitioner or
authorized signatory, I may be required to submit original documents to USCIS at a later date.
I authorize the release of any information contained in this petition, in supporting documents, in my USCIS records, and in the
petitioning organization's USCIS 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.
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) I reviewed and provided or authorized all of the information in my petition;
2) I understood all of the information contained in, and submitted with, my petition; and
3) All of this information was complete, true, and correct at the time of filing.
I certify, under penalty of perjury, that I provided or authorized all of the information in my petition, I understand all of the
information contained in, and submitted with, my petition, and that all of this information is complete, true, and correct.

Form I-129H2B xx/xx/19

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Part 7. Statement, Contact Information, Certification, and Signature of the Petitioner or Authorized
Signatory (continued)
Petitioner's or Authorized Signatory's Signature
8.

Petitioner's or Authorized Signatory's Signature

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 deny your petition.

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Part 8. Interpreter's Contact Information, Certification, and Signature
Provide the following information about the interpreter.

Interpreter's Full Name
1.

Interpreter's Family Name (Last Name)

Interpreter's Given Name (First Name)

2.

Interpreter's Business or Organization Name (if any)

Interpreter's Mailing Address
3.

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

Postal Code

ZIP Code

Country

Interpreter's Contact Information
4.

Interpreter's Daytime Telephone Number

6.

Interpreter's Email Address (if any)

5.

Interpreter's Mobile Telephone Number (if any)

Interpreter's Certification
I certify, under penalty of perjury, that:
I am fluent in English and

, which is the same language specified in Part 7.,

Item B. in Item Number 1., 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
Certification, and has verified the accuracy of every answer.

Form I-129H2B xx/xx/19

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Part 8. Interpreter's Contact Information, Certification, and Signature (continued)
Interpreter's Signature
7.

Interpreter's Signature

Date of Signature (mm/dd/yyyy)

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

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Provide the following information about the preparer.

Preparer's Full Name
1.

Preparer's Family Name (Last Name)

Preparer's Given Name (First Name)

2.

Preparer's Business or Organization Name (if any)

Preparer's Mailing Address
3.

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

Postal Code

ZIP Code

Country

Preparer's Contact Information
4.

Preparer's Daytime Telephone Number

6.

Preparer's Email Address (if any)

5.

Preparer's Mobile Telephone Number (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 or authorized signatory's consent.

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 supplement.
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, or Form G-28I, Notice of Entry of Appearance as
Attorney In Matters Outside the Geographical Confines of the United States, with this petition.

Form I-129H2B xx/xx/19

Page 14 of 19

Part 9. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other
Than the Petitioner (continued)
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 or authorized signatory has reviewed this completed petition, including the Petitioner's or Authorized Signatory's
Certification, and informed me that all of the information in the petition and in the supporting documents is complete, true, and
correct.

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Preparer's Signature
8.

Preparer's Signature

Form I-129H2B xx/xx/19

Date of Signature (mm/dd/yyyy)

Page 15 of 19

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 company or organization name 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.

Individual Petitioner or Company Name

2.

A.

Page Number

B. Part Number

C. Item Number

Page Number

B. Part Number

C. Item Number

Page Number

B. Part Number

C. Item Number

Page Number

B. Part Number

C. Item Number

Page Number

B. Part Number

C. Item Number

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D.

3.

A.

D.

4.

A.

D.

5.

A.

D.

6.

A.

D.

Form I-129H2B xx/xx/19

Page 16 of 19

Named Worker Attachment for
Form I-129H2B

USCIS
Form I-129H2B

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

OMB No. 1615-xxxx
Expires xx/xx/20xx

Complete a separate copy of this attachment for each additional beneficiary included in this petition. (Do not complete a copy of this
Attachment for the beneficiary you already named in Part 3. of Form I-129H2B.)

Petitioner's Information
Provide the same petitioner name information that was provided in Part 1. of Form I-129H2B, as applicable.
1.

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Legal Name of Petitioning Individual or Sole Proprietor
Family Name (Last Name)

2.

Given Name (First Name)

Middle Name (if applicable)

Given Name (First Name)

Middle Name

Company or Organization Name

Beneficiary's Information
3.

Name of Beneficiary

Family Name (Last Name)

4.

Provide all other names the beneficiary has used. Include nicknames, aliases, maiden name, and names from all previous
marriages.
Family Name (Last Name)

Other Information
5.

Date of birth (mm/dd/yyyy)

Given Name (First Name)

6.

Gender

7.

Male

8.

Alien Registration Number (A-Number)
►

A-

9.

Middle Name

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

Female

USCIS Online Account Number (if any)
►

10.

City or Town of Birth

11.

Province of Birth

12.

Country of Birth

13.

Country of Citizenship or Nationality

14.

Beneficiary's Foreign Address
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

Form I-129H2B xx/xx/19

Postal Code

ZIP Code

Country

Page 17 of 19

Other Information (continued)
15.

If the beneficiary is in the United States, complete the following:
Date of Last Arrival (mm/dd/yyyy)

Form I-94 Arrival-Departure Record Number (if any)
►

Passport or Travel Document
Number

Date Passport or Travel
Document Issued (mm/dd/yyyy)

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Date Passport or Travel Document
Expires (mm/dd/yyyy)

Passport or Travel Document Country
of Issuance

Current Nonimmigrant
Status

Date Status Expires (mm/dd/yyyy) or Duration of Status (D/S)
(see Form I-94 Arrival/Departure Document)

Student and Exchange Visitor Information System
(SEVIS) Number (if any)

16.

Employment Authorization Document (EAD)
Number (if any)

Does the beneficiary have a U.S. residential address?

Yes

No

If you answered “Yes” to Item Number 16., you must provide the beneficiary's U.S. residential address information in Item
Number 17.
17.

18.

Beneficiary's Current U.S. Residential Address (Do not list a P.O. Box unless the beneficiary resides in the Commonwealth of
the Northern Mariana Islands (CNMI).)
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Provide the most recent petition/application receipt number for the beneficiary. If none exists, indicate "None."
►

19.

ZIP Code

Have you ever filed an immigrant petition for this beneficiary?

Yes

No

Yes

No

Yes

No

If you answered “Yes” to Item Number 19., identify the classification sought and the receipt numbers
for those petitions in Part 10. Additional Information.
20.

Have you ever filed a nonimmigrant petition for this beneficiary?
If you answered “Yes” to Item Number 20., identify the classification sought and the receipt numbers
for those petitions in Part 10. Additional Information.

21.

Has this beneficiary ever been denied H-2B classification on any prior petition you filed on behalf of
this beneficiary?
If you answered “Yes” to Item Number 21., identify the classification sought and the receipt numbers
for those petitions in Part 10. Additional Information.

Form I-129H2B xx/xx/19

Page 18 of 19

Other Information (continued)
22.

List the beneficiary's prior periods of stay in H or L classification in the United States for the last three years. Be sure to only
list those periods in which the beneficiary was actually in the United States in an H or L classification. Do not include periods
in which the beneficiary was in a dependent status, for example, H-4 or L-2 status. If you need more space, use Part 10.
Additional Information or attach an additional sheet of paper.
NOTE: Submit copies of any available Forms I-94, I-797, and/or other USCIS issued documents noting these periods of stay in
the H or L classification.
Employer's Name

23.

Period of Stay
From (mm/dd/yyyy) To (mm/dd/yyyy)

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Has this beneficiary experienced an interrupted stay associated with their entry in H or L classification?
(See form Instructions for more information on interrupted stays.)

Yes

No

If you answered “Yes” to Item Number 23., submit evidence of each entry and each exit as evidence of
the interrupted stays.

Form I-129H2B xx/xx/19

Page 19 of 19