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 12/31/2020

For USCIS Use Only
Partial Approval (explain)

Receipt

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

Action Block

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Classification Approved

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

If you are an individual employer or sole proprietor filing this
application, complete Item Numbers 1.a. - 2. All petitioners
should complete Item Numbers 3. - 9.c.

4.g. If your place of business does not have a physical address,
provide a description of your location, (for example: “3
miles southwest of Anytown Post Office, near the water
tower”) and provide a map with your petition. If you
need more space to provide your explanation, use the
space provided in Part 11. Additional information.

Legal Name of Individual Petitioner or Sole
Proprietor
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)

5.

1.c. Middle Name
2.

Petitioner's Contact Information

Date of Birth (mm/dd/yyyy)

6.a. Daytime Telephone Number

Petitioning Company or Organization Name and
Address
3.

Trade Name or "Doing Business As" Name

6.b. Mobile Telephone Number

Name of Employer/Organization
6.c. Email Address

4.a. In Care Of Name

4.b. Street Number
and Name
4.c.

Apt.

Ste.

Flr.

4.d. City or Town
4.e. State

4.f.

ZIP Code
(USPS ZIP Code Lookup)

Form I-129CW Edition 06/18/20

Page 1 of 15

Part 1. Information about the Employer Filing
This Petition (continued)

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

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

Taxpayer Identification Numbers

3.b.

Change the worker's status and extend their stay since
the worker is in the CNMI in another status. This
option is available only if you selected Item Number
1.a., “New Employment” as the Basis for
Classification (see the Instructions for limitations).

Provide the following information as applicable:

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7.a. Employer Identification Number (EIN)

7.b.

Individual Taxpayer Identification Number (ITIN)

3.c.

Extend stay of each worker since they now hold this
status.

3.d.

Amend the stay of each worker since they now hold
this status.

7.c. U.S. Social Security Number
►

8.

USCIS Online Account Number
►

E-Verify Information

9.a. Do you certify that you are a participant in good standing
in the E-Verify program?
Yes
No
9.b. Employer's Name as Listed in E-Verify

9.c. Employer's E-Verify Company Identification Number or a
Valid E-Verify Client Company Identification Number

If you selected Item Number 3.b., indicate the type of status
change you are requesting (Select only one box):
4.a.

Initial Grant of CW-1 Status in CNMI.

4.b.

Change of Federal Nonimmigrant Status to CW-1

5.

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

6.a. Are you requesting a long-term CW-1 worker(s)?
Yes

No

6.b. If you answered “Yes” to Item Number 6.a., how much
time are you are requesting for the CW-1 long-term
worker(s)?
Up to 1 Year

Part 2. Information About This Petition
Basis for Classification (Select only one box):
1.a.

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

1.b.

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

1.c.

Change in previously approved employment (provide
an explanation in Part 11. Additional Information).

1.d.

New concurrent employment.

1.e.

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

1.f.

Amended petition (provide an explanation in Part 11.
Additional Information).

2.

Prior Petition. Provide the most recent petition receipt
number for the worker. If none exists, type or print
“None.”
►

Form I-129CW Edition 06/18/20

More Than 1 Year, up to 2 Years
More Than 2 Years, up to 3 Years

6.c. If you answered “Yes” to Item Number 6.a., did each
worker continuously maintain CW-1 nonimmigrant status
during the required fiscal years?
Yes
No

Part 3. Worker Information
Provide the information requested about the worker(s) for
whom you are filing. If you are providing information for more
than one worker, complete a separate copy of the Additional
Worker Attachment for Form I-129CW for each additional
worker.

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

Page 2 of 15

Part 3. Worker Information (continued)

If the worker is in the CNMI, provide the information requested
in Item Numbers 12. - 17.

Other Names the Worker Has Used

12.

Date of Last Arrival (mm/dd/yyyy)

Include nicknames, aliases, maiden name, and names from all
previous marriages.

13.

Form I-94 Arrival-Departure Record Number

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

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14.a. Passport or Travel Document Number

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

2.c. Middle Name

Other Information

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

3.

Date of Birth (mm/dd/yyyy)

4.

Gender

5.

U.S. Social Security Number

Male

14.d. Passport or Travel Document Country of Issuance

Female

15.a. Current Nonimmigrant Status

►

6.

Alien Registration Number (A-Number)
► A-

7.

City or Town of Birth

8.

State or Province of Birth

9.

Country of Birth

10.

Country of Citizenship or Nationality

Worker's Foreign Address

Apt.

16.

Student and Exchange Visitor Information System
(SEVIS) Number

17.

Employment Authorization Document (EAD) Number

If the worker is in the CNMI, provide their current residential
address.
18.a. Street Number
and Name
18.b.

11.a. Street Number
and Name
11.b.

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

Apt.

Flr.

18.c. City or Town

Ste.

Flr.
18.d. State

11.c. City or Town
11.d. State

Ste.

19.
11.e. ZIP Code

11.h. Country

Have you ever filed an immigrant petition for this
worker?
Yes

No

If you answered “Yes” to Item Number 19., identify the
classification sought and the receipt number for those
petitions in Part 11. Additional Information.

11.f. Province
11.g. Postal Code

18.e. ZIP Code

20.

Have you ever filed a nonimmigrant petition for this
worker?
Yes
No
If you answered “Yes” to Item Number 20., identify the
classification sought and the receipt number for those
petitions in Part 11. Additional Information.

Form I-129CW Edition 06/18/20

Page 3 of 15

Part 3. Worker Information (continued)

Part 4. Processing Information

21.

If any of the workers in Part 3. Worker Information or in an
Additional Worker Attachment for Form I-129CW are
outside the CNMI, or if a requested extension of stay or change
of status cannot be granted, provide the U.S. Consulate or CBP
inspection facility you want notified if this petition is approved.

Has this worker ever been denied CW-1 classification on
any prior petition you filed on behalf of this beneficiary?
Yes
No
If you answered “Yes” to Item Number 21., identify the
receipt number for the petition and the date of the decision
in Part 11. Additional Information.

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Provide the worker's prior periods of stay in CW-1 classification
in the United States for the last three years in Item Numbers
22.a. - 24.c.. Be sure to only provide those periods in which the
worker was actually in the CNMI in CW-1 status. Do not
include periods in which the worker was in a dependent status,
for example, CW-2 status. If you need extra space to complete
this section, use the space provided in Part 11. Additional
Information.

NOTE: Submit copies of any available Forms I-94, I-797, and/
or other USCIS issued documents noting these periods of stay
in the CW-1 classification. (If more space is needed, attach an
additional sheet.)
Period of Stay 1
22.a. Employer's Name

1.a. Type of Office (Select only one box):
U.S. Embassy or U.S. Consulate
CBP Pre-flight Inspection
U.S. Port of Entry

1.b. Office Location (City or Town)

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

2.

If you answered “No” to Item Number 2., type or print a
brief explanation in Part 11. Additional Information.

3.

22.b. Period of Stay From (mm/dd/yyyy)
22.c. To (mm/dd/yyyy)
Period of Stay 2
23.a. Employer's Name

Does each worker in this petition have a valid passport?
No
Yes

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

4.

No

►

Have you previously filed any other petitions based on the
same temporary labor certification as this petition?
Yes
No
If you answered “Yes” to Item Number 4., provide the
previous receipt numbers(s).

23.b. Period of Stay From (mm/dd/yyyy)
23.c. To (mm/dd/yyyy)
Period of Stay 3

5.

Are you filing any applications for dependents with this
petition?
Yes
No

24.a. Employer's Name
If yes, how many?
6.

►

24.b. Period of Stay From (mm/dd/yyyy)

Is any worker in this petition in removal proceedings?
Yes
No

24.c. To (mm/dd/yyyy)

If yes, how many?

►

Provide the name and A-Number of each worker in
removal proceedings in Part 11. Additional Information.

Form I-129CW Edition 06/18/20

Page 4 of 15

If you answered “Yes” to Item Number 5., you must
submit a detailed itinerary with your petition.

Part 4. Processing Information (continued)
7.a. Does any worker in this petition have ownership interest
in the petitioning organization?
Yes
No

If you answered “No” to Item Number 5., provide the
address where the worker(s) will work if different from
the address in Part 1. If the location has no address,
describe the location where the worker will work and
provide a map with your petition. If you need more
space, use the space provided in Part 11. Additional
Information.

7.b. If you answered “Yes” to Item Number 7.a., provide an
explanation of the worker's ownership interests.

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8.a. Are you or the employer currently debarred by the U.S.
Department of Labor (DOL)?
Yes
No

6.a. Street Number
and Name
6.b.

Apt.

8.b. Has the temporary labor certification supporting this
petition been revoked by DOL?
Yes
No

6.c. City or Town

8.c. Have you or the employer ever received a final order of
debarment from DOL in any foreign labor certification
program?
Yes
No

6.d. State

8.d. If you answered “Yes” to Item Numbers 8.a., 8.b., or
8.c., please explain.

7.

Ste.

Flr.

6.e. ZIP Code

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

8.a. Is this a full-time position?

No
No

8.b. If you answered “No” to Item Number 8.a., how many
hours of work per week for the position?

9.a. Is this petition exempt from the CW-1 numerical limit (or
cap) because the worker(s) has been previously counted
against the CW-1 cap in the same fiscal year?
Yes
No

9.a. Wages: $

►

per (specify hour, week,

month, or year)

9.b. Other Compensation (Explain)

9.b. If you answered “Yes” to Item Number 9.a., provide the
receipt number.
►
10.

Are you requesting consideration under the governor's cap
reservation?
Yes
No

Dates of Intended Employment
10.a. Date From (mm/dd/yyyy)

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

Job Title

2.

Employment and Training Administration (ETA) Case
Number For Temporary Labor Certification (TLC)

►

11.

Type of Business

12.

Year Established

13.

Current Number of Employees

14.

Gross Annual Income

15.

Net Annual Income

-

3.

SOC Code

4.

Nontechnical Job Description

5.

Will the worker(s) be working at multiple worksites?
Yes
No

Form I-129CW Edition 06/18/20

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

Page 5 of 15

Part 6. Information about the Beneficiary's
Public Benefits

A.

Agency that Granted the Benefit

This Part 6. only applies to beneficiaries who are seeking to
change nonimmigrant status or extend their nonimmigrant stay
while they are in the CNMI. If the beneficiary is not seeking a
change of status or extension of stay, you may skip this Part 6.

Date the Beneficiary Started Receiving the Benefit
or if Certified, Date the Beneficiary Will Start
Receiving the Benefit (mm/dd/yyyy)

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Provide the requested information and submit documentation as
outlined in the Instructions. For additional beneficiaries, please
respond to the questions in Part 2., Information about the
Additional Beneficiary's Public Benefits, in the Form
I-129CW Classification Supplement.
1.

Type of Benefit

Has the beneficiary, since obtaining the nonimmigrant
status that you seek to change on behalf of the
beneficiary, received, or is the beneficiary currently
certified to receive, any of the following public benefits?
(Select all that apply)

Date Benefit or Coverage Ended or Expire
(mm/dd/yyyy)

B.

Type of Benefit

Agency that Granted the Benefit

Yes, the beneficiary has received or is currently
certified to receive the following benefits (select all
that apply):

Date the Beneficiary Started Receiving the Benefit
or if Certified, Date the Beneficiary Will Start
Receiving the Benefit (mm/dd/yyyy)

Any Federal, State, Local, or Tribal Cash
Assistance For Income Maintenance
Supplemental Security Income (SSI)

Date Benefit or Coverage Ended or Expires
(mm/dd/yyyy)

Temporary Assistance for Needy Families
(TANF)
General Assistance (GA)

Supplemental Nutrition Assistance Program
(SNAP, formerly called “Food Stamps”)

Section 8 Housing Assistance under the Housing
Choice Voucher Program
Section 8 Project-Based Rental Assistance
(including Moderate Rehabilitation)
Public Housing under the Housing Act of 1937,
42 U.S.C. 1437 et seq.
Federally-funded Medicaid

No, the beneficiary has not received any of the above
listed public benefits.

C.

Type of Benefit

Agency that Granted the Benefit

Date the Beneficiary Started Receiving the Benefit
or if Certified, Date the Beneficiary Will Start
Receiving the Benefit (mm/dd/yyyy)

Date Benefit or Coverage Ended or Expires
(mm/dd/yyyy)

No, the beneficiary is not certified to receive any of
the above listed public benefits.
2.

If the beneficiary has received or is currently certified to
receive any of the above public benefits, provide
information about the public benefits below. If you need
additional space to complete any Item Number in this
Part, use the space provided in Part 11. Additional
Information. Submit evidence as outlined in the
Instructions.

Form I-129CW Edition 06/18/20

Page 6 of 15

Part 6. Information about the Beneficiary's
Public Benefits (continued)
D.

Type of Benefit

4.a. Has the beneficiary received, applied for, or have been
certified to receive federally-funded Medicaid in
connection with any of the following (select all that
apply):
NOTE: Submit evidence as outlined in the Instructions.

Agency that Granted the Benefit

An Emergency Medical Condition

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For a Service Under the Individuals with Disabilities
Education Act (IDEA)

Date the Beneficiary Started Receiving the Benefit
or if Certified, Date the Beneficiary Will Start
Receiving the Benefit (mm/dd/yyyy)

Other School-based Benefits or Services Available
Up to the Oldest Age Eligible for Secondary
Education Under State Law
While Under 21 Years of Age

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

If you answered “Yes” to Item Number 1., do any of the
following apply to the beneficiary? Provide the evidence
listed in the Form I-129CW Instructions.

The beneficiary is enlisted in the U.S. Armed Forces,
or is serving in active duty or in the Ready Reserve
Component of the U.S. Armed Forces.
The beneficiary is the spouse or the child of an
individual who is enlisted in the U.S. Armed Forces,
or who is serving in active duty or in the Ready
Reserve Component of the U.S. Armed Forces.

While Pregnant or During the 60-day Period
Following the Last Day of Pregnancy

4.b. Provide the Applicable Dates
Start Date (mm/dd/yyyy)

End Date (mm/dd/yyyy)

Part 7. Employer's Attestation

The above named petitioning employer has not displaced and
will not displace a United States worker in order to employ the
worker as agreed to in the application for Temporary Labor
Certification.

At the time the beneficiary received the public
benefits, the beneficiary (or the beneficiary's spouse
or parent) was enlisted in the U.S. Armed Forces, or
was serving in active duty or in the Ready Reserve
Component of the U.S. Armed Forces.

The above named petitioning employer is a legitimate business
as defined in the regulations at 8 CFR 214.2(w)(1)(vii).

At the time the beneficiary received the public
benefits, the beneficiary was present in the United
States in a status exempt from the public charge
ground of inadmissibility and the beneficiary
received the public benefits during that time.

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.

At the time the beneficiary received the public
benefits, the beneficiary was present in the United
States after being granted a waiver of the public
charge ground of inadmissibility.

Each worker meets the qualifications for the position.

The beneficiary is a child currently residing abroad
who entered the United States with a nonimmigrant
visa to attend an N-600K, Application for Citizenship
and Issuance of Certificate Under INA Section 322
interview.

The above named petitioning employer is doing business as
defined in the regulations at 8 CFR 214.2(w)(1)(iii).

Each worker, 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 including H-2A or H-2B.

None of the above statements apply to the
beneficiary.

Form I-129CW Edition 06/18/20

Page 7 of 15

Part 7. Employer's Attestation (continued)
The position falls within the list of occupational categories
designated by USCIS (Select only one box):

Part 8. Statement, Contact Information,
Certification, and Signature of the Petitioner or
Authorized Signatory

5.a.

Professional, Technical, or Management Occupations

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

5.b.

Clerical and Sales Occupations

5.c.

Service Occupations

5.d.

Agricultural, Fisheries, Forestry, and Related
Occupations

5.e.

Processing Occupations

NOTE: Select the box for either Item Number 1.a. or 1.b.
If applicable, select the box for Item Number 2.

5.f.

Machine Trade Occupations

1.a.

5.g.

Benchwork Occupations

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.

5.h.

Structural Occupations

1.b.

5.i.

Miscellaneous Occupations

The interpreter named in Part 9. has read to me every
question and instruction on this petition and my
answer to every question in

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Petitioner's or Authorized Signatory's Statement

The above named petitioning employer will pay each worker a
wage that is not less than the greater of:

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

1) The CNMI minimum wage;

2) The Federal minimum wage; or

2.

3) The prevailing wage in the CNMI for the occupation in
which the worker will be employed as established by
the U.S. Department of Labor; and
The above named petitioning employer will comply with the
reporting and retention requirements in 8 CFR 214.2(w)(26).

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.
6.

Employer's Printed Name

7.

Title

8.

Employer/Organization Name

,

At my request, the preparer named in Part 10.,
,

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)

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)

Employer's Signature
9.a. Employer's Signature

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

Form I-129CW Edition 06/18/20

Page 8 of 15

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

2.

Interpreter's Business or Organization Name (if any)

Interpreter's Mailing Address
Petitioner's or Authorized Signatory's Certification

3.a. Street Number
and Name

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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.

3.b.

Apt.

Ste.

Flr.

3.c. City or Town

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.

3.d. State

If filing this petition on behalf of an organization, I certify that I
am authorized to do so by the organization.

4.

Interpreter's Daytime Telephone Number

5.

Interpreter's Mobile Telephone Number (if any)

6.

Interpreter's Email Address (if any)

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.

3.f.

3.e. ZIP Code

Province

3.g. Postal Code
3.h. Country

Interpreter's Contact Information

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

Interpreter's Certification

I certify, under penalty of perjury, that:
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 9. Interpreter's Contact Information,
Certification, and Signature
Provide the following information about the interpreter.

Interpreter's Full Name

I am fluent in English and

,

which is the same language specified in Part 8., 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 Certification, and has verified the
accuracy of every answer.

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

1.a. Interpreter's Family Name (Last Name)
7.b. Date of Signature (mm/dd/yyyy)
1.b. Interpreter's Given Name (First Name)

Form I-129CW Edition 06/18/20

Page 9 of 15

Part 10. Contact Information, Declaration, and
Signature of the Person Preparing This Petition,
if Other Than the Petitioner or Authorized
Signatory

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.

Provide the following information about the preparer.

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.

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Preparer's Full Name

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

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

2.

Preparer's Statement

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.

Preparer's Business or Organization Name (if any)

Preparer's Certification

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

Apt.

3.c. City or Town

Ste.

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 Certification, and informed me that all of this
information in the form and in the supporting documents is
complete, true, and correct.

Preparer's Signature

3.d. State
3.f.

Province

3.g. Postal Code
3.h. Country

3.e. ZIP Code

8.a. Preparer's Signature

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

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 Edition 06/18/20

Page 10 of 15

5.a. Page Number

Part 11. 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 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.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name
2.

A-Number

3.a. Page Number

3.d.

4.a. Page Number

5.b. Part Number

5.c. Item Number

5.d.

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3.b. Part 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 Edition 06/18/20

4.c. Item Number

7.a. Page Number

7.d.

Page 11 of 15

Additional Worker Attachment for Form I-129CW
Department of Homeland Security
U.S. Citizenship and Immigration Services

Complete a separate copy of this attachment for each additional
worker included in this petition. (Do not complete a copy of
this Attachment for the worker you already named in Part 3. of
Form I-129CW.)
Provide the same petitioner name information that was provided
in Part 1. of Form I-129CW.

OMB No. 1615-0111
Expires 12/31/2020

Other Names the Worker Has Used
Include nicknames, aliases, maiden name, and names from all
previous marriages.
5.a. Family Name
(Last Name)
5.b. Given Name
(First Name)

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Legal Name of Individual Petitioner or Sole
Proprietor
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)

USCIS
Form I-129CW

5.c. Middle Name

Other Information

6.

Date of Birth (mm/dd/yyyy)

7.

Gender

Petitioning Company or Organization Name and
Address

8.

U.S. Social Security Number

2.

9.

1.c. Middle Name

Name of Employer/Organization

Male

Female

►

Alien Registration Number (A-Number)
► A-

3.a. In Care Of Name

3.c. Street Number
and Name
3.d.

Apt.

Ste.

3.e. City or Town
3.f.

State

Flr.

3.g. ZIP Code

10.

City or Town of Birth

11.

State or Province of Birth

12.

Country of Birth

13.

Country of Citizenship or Nationality

(USPS ZIP Code Lookup)

Information About the Worker

Worker's Foreign Address

Worker's Full Name

14.a. Street Number
and Name

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

14.b.

Apt.

Ste.

Flr.

14.c. City or Town
14.d. State

14.e. ZIP Code

14.f. Province
14.g. Postal Code
14.h. Country

Form I-129CW Edition 06/18/20

Page 12 of 15

If the worker is in the CNMI, provide the information requested
in Item Numbers 15. - 20.
15.

Date of Last Arrival (mm/dd/yyyy)

16.

Form I-94 Arrival-Departure Record Number

24.

Has this worker ever been denied CW-1 classification on
any prior petition you filed on behalf of this beneficiary?
Yes
No
If you answered “Yes” to Item Number 24., identify the
receipt number for the petition and the date of the
decision in Part 11. Additional Information.

►

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Provide the worker's prior periods of stay in CW-1
classification in the United States for the last three years in Item
Numbers 25.a. - 27.c. Be sure to only provide those periods in
which the worker was actually in the CNMI in CW-1 status.
Do not include periods in which the worker was in a dependent
status (for example, CW-2 status). If you need extra space to
complete this section, use the space provided in Part 11.
Additional Information.

17.a. Passport or Travel Document Number

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

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

NOTE: Submit copies of any available Forms I-94, I-797, and/
or other USCIS issued documents noting these periods of stay
in the CW-1 classification. (If more space is needed, attach an
additional sheet.)

17.d. Passport or Travel Document Country of Issuance

18.a. Current Nonimmigrant Status

Period of Stay 1

25.a. Employer's Name

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

25.b. Period of Stay From (mm/dd/yyyy)

19.

Student and Exchange Visitor Information System
(SEVIS) Number

25.c. To (mm/dd/yyyy)
Period of Stay 2

20.

Employment Authorization Document (EAD) Number

26.a. Employer's Name

26.b. Period of Stay From (mm/dd/yyyy)

If the worker is in the CNMI, provide their current residential
address.

26.c. To (mm/dd/yyyy)

21.a. Street Number
and Name

Period of Stay 3

21.b.

Apt.

Ste.

Flr.

27.a. Employer's Name

21.c. City or Town
21.d. State
22.

27.b. Period of Stay From (mm/dd/yyyy)

21.e. ZIP Code

Have you ever filed an immigrant petition for this
worker?
Yes

27.c. To (mm/dd/yyyy)
No

If you answered “Yes” to Item Number 22., identify the
classification sought and the receipt number for those
petitions in Part 11. Additional Information.
23.

Have you ever filed a nonimmigrant petition for this
worker?
No
Yes
If you answered “Yes” to Item Number 23., identify the
classification sought and the receipt number for those
petitions in Part 11. Additional Information.

Form I-129CW Edition 06/18/20

Page 13 of 15

Date the Beneficiary Started Receiving the Benefit
or if Certified, Date the Beneficiary Will Start
Receiving the Benefit (mm/dd/yyyy)

Information about the Additional Beneficiary's
Public Benefits
28.

Has the beneficiary, since obtaining the nonimmigrant
status that you seek to extend or that you seek to change
on behalf of the beneficiary, received, or is the
beneficiary currently certified to receive, any of the
following public benefits (select all that apply)?

Date Benefit or Coverage Ended or Expires
(mm/dd/yyyy)

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Yes, the beneficiary has received or is currently
certified to receive the following benefits:

B.

Any Federal, State, Local or Tribal Cash
Assistance For Income Maintenance

Type of Benefit

Agency that Granted the Benefit

Supplemental Security Income (SSI)

Temporary Assistance for Needy Families
(TANF)

Date the Beneficiary Started Receiving the Benefit
or if Certified, Date the Beneficiary Will Start
Receiving the Benefit (mm/dd/yyyy)

General Assistance (GA)

Supplemental Nutrition Assistance Program
(SNAP, formerly called “Food Stamps”)

Date Benefit or Coverage Ended or Expires
(mm/dd/yyyy)

Section 8 Housing Assistance under the Housing
Choice Voucher Program
Section 8 Project-Based Rental Assistance
(including Moderate Rehabilitation)

C.

Public Housing under the Housing Act of 1937,
42 U.S.C. 1437 et seq.

Type of Benefit

Agency that Granted the Benefit

Federally-Funded Medicaid

No, the beneficiary has not received any of the above
listed public benefits.

Date the Beneficiary Started Receiving the Benefit
or if Certified, Date the Beneficiary Will Start
Receiving the Benefit (mm/dd/yyyy)

No, the beneficiary is not certified to receive any of
the above listed public benefits.
29.

If the beneficiary has received or is currently certified to
receive any of the above public benefits, provide
information about the public benefits, below. If you need
additional space to complete any Item Number in this
Part, use the space provided in Part 11. Additional
Information. Submit evidence as outlined in the
Instructions.

Date Benefit or Coverage Ended or Expires
(mm/dd/yyyy)

D.

Type of Benefit

Agency that Granted the Benefit

A.

Type of Benefit

Agency that Granted the Benefit

Form I-129CW Edition 06/18/20

Date the Beneficiary Started Receiving the Benefit
or if Certified, Date the Beneficiary Will Start
Receiving the Benefit (mm/dd/yyyy)

Date Benefit or Coverage Ended or Expires
(mm/dd/yyyy)

Page 14 of 15

30.

If you answered “Yes” to Item Number 1., do any of the
following apply to the beneficiary? Provide the evidence
listed in the Form I-129CW Instructions.
The beneficiary is enlisted in the U.S. Armed Forces,
or is serving in active duty or in the Ready Reserve
Component of the U.S. Armed Forces.

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The beneficiary is the spouse or the child of an
individual who is enlisted in the U.S. Armed Forces,
or who is serving in active duty or in the Ready
Reserve Component of the U.S. Armed Forces.
At the time the beneficiary received the public
benefits, the beneficiary (or the beneficiary's spouse
or parent) was enlisted in the U.S. Armed Forces, or
was serving in active duty or in the Ready Reserve
Component of the U.S. Armed Forces.
At the time the beneficiary received the public
benefits, the beneficiary was present in the United
States in a status exempt from the public charge
ground of inadmissibility.

At the time the beneficiary received the public
benefits, the beneficiary was previously present in the
United States after being granted a waiver of the
public charge ground of inadmissibility.
The beneficiary is a child currently residing abroad
who entered the United States with a nonimmigrant
visa to attend an N-600K, Application for Citizenship
and Issuance of Certificate Under INA Section 322,
interview.
None of the above statements apply to the
beneficiary.

31.a. Has the beneficiary received, applied for, or has been
certified to receive federally-funded Medicaid in
connection with any of the following (select all that
apply):
NOTE: Submit evidence as outlined in the Instructions.
An Emergency Medical Condition
For a Service Under the Individuals with Disabilities
Education Act (IDEA)
Other School-based Benefits or Services Available
Up to the Oldest Age Eligible for Secondary
Education Under State Law
While Under 21 Years of Age
While Pregnant or During the 60-day Period
Following the Last Day of Pregnancy
31.b. Provide the Applicable Dates
Start Date (mm/dd/yyyy)

Form I-129CW Edition 06/18/20

End Date (mm/dd/yyyy)

Page 15 of 15