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 09/30/2024

For USCIS Use Only
Partial Approval (explain)

Receipt

Action Block

Classification Approved

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

Consulate/POE/PFI Notified
At:

Extension Granted

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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 10. 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)

Petitioning Company or Organization Name and
Address
(USPS ZIP Code Lookup)
3.

Trade Name or "Doing Business As" Name (if applicable)

6.a. Daytime Telephone Number

6.b. Mobile Telephone Number (if any)

Name of Employer/Organization

6.c. Email Address (if any)

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

Taxpayer Identification Numbers
4.b. Street Number
and Name
4.c.

Apt.

Provide the following information as applicable:

Ste.

Flr.

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

7.a. Employer Identification Number (EIN)

7.b.
4.f.

Individual Taxpayer Identification Number (ITIN)

ZIP Code

Form I-129CW Edition 09/03/21

Page 1 of 12

Part 1. Information about the Employer Filing
This Petition (continued)
7.c. U.S. Social Security Number (if any)
►
8.
9.

Are you a nonprofit organized as tax exempt or a
governmental research organization?
Yes

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

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

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).

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.

No

USCIS Online Account Number (if any)
►

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E-Verify Information

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

11.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):
►

Part 2. Information About This Petition
Basis for Classification (Select only one box):
1.a.
1.b.
1.c.
1.d.
1.e.
1.f.
2.

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

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

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)?

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

Up to 1 Year

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

More Than 2 Years, up to 3 Years

New concurrent employment.

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

Amended petition (provide an explanation in Part 10.
Additional Information).
Prior Petition. Provide the most recent petition receipt
number for the worker. If none exists, type or print
“None.”
►

No

More Than 1 Year, up to 2 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

Form I-129CW Edition 09/03/21

Page 2 of 12

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)

►
14.a. Passport or Travel Document Number

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2.c. Middle Name

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

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 (if any)

Male

14.d. Passport or Travel Document Country of Issuance

Female

15.a. Current Nonimmigrant Status

►

6.

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

Apt.

16.

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

17.

Employment Authorization Document (EAD) Number (if
any)

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 10. 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 10. Additional Information.

Form I-129CW Edition 09/03/21

Page 3 of 12

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 10. Additional Information.

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 10. Additional
Information.

1.a. Type of Office (Select only one box):
U.S. Embassy or U.S. Consulate

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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.)

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.

Period of Stay 1

If you answered “No” to Item Number 2., type or print a
brief explanation in Part 10. Additional Information.

22.a. Employer's Name

3.

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

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.

Period of Stay 2

23.a. Employer's Name

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 10. Additional Information.

Form I-129CW Edition 09/03/21

Page 4 of 12

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 10. Additional
Information.

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

6.a. Street Number
and Name

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

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.

Do you currently employ a total of 25 or fewer full-time
equivalent employees in the United States, including all
affiliates or subsidiaries of this company/organization?
Yes
No

15.

Gross 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 09/03/21

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

Page 5 of 12

Part 6. Employer's Attestation
16.

Net Annual Income

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.

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

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

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7.

Title

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.

8.

Employer/Organization Name

Each worker meets the qualifications for the position.

9.a. Employer's Signature

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

Employer's Signature

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.
The position falls within the list of occupational categories
designated by USCIS (Select only one box):
5.a.
5.b.
5.c.
5.d.

Professional, Technical, or Management Occupations
Clerical and Sales Occupations
Service Occupations

Agricultural, Fisheries, Forestry, and Related
Occupations

5.e.

Processing Occupations

5.f.

Machine Trade Occupations

5.g.

Benchwork Occupations

5.h.

Structural Occupations

5.i.

Miscellaneous Occupations

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

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

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.

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

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
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

2.

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

The above named petitioning employer will comply with the
reporting and retention requirements in 8 CFR 214.2(w)(26).

Form I-129CW Edition 09/03/21

Page 6 of 12

Part 7. Statement, Contact Information,
Certification, and Signature of the Petitioner or
Authorized Signatory (continued)
Petitioner's or Authorized Signatory's Contact
Information
3.a. Authorized Signatory's Family Name (Last Name)

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

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.

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

4.

Authorized Signatory's Title

5.

Authorized Signatory's Daytime Telephone Number

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

Provide the following information about the interpreter.

Interpreter's Full Name

6.

Authorized Signatory's Mobile Telephone Number (if any)

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

7.

Authorized Signatory's Email Address (if any)

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

2.

Interpreter's Business or Organization Name (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, 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.

Interpreter's Mailing Address

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

Apt.

Ste.

Flr.

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

3.e. ZIP Code

Province

3.g. Postal Code
3.h. Country

If filing this petition on behalf of an organization, I certify that I
am authorized to do so by the organization.
I certify, under penalty of perjury, that I have reviewed this
petition, I understand all of the information contained in, and
submitted with, my petition, and all of this information is
complete, true, and correct.

Form I-129CW Edition 09/03/21

Interpreter's Contact Information
4.

Interpreter's Daytime Telephone Number

5.

Interpreter's Mobile Telephone Number (if any)

6.

Interpreter's Email Address (if any)

Page 7 of 12

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

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

Interpreter's Certification

3.b.

Apt.

Ste.

Flr.

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

,

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

3.e. ZIP Code

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

3.f.

Province

3.g. Postal Code
3.h. Country

Preparer's Contact Information

4.

Preparer's Daytime Telephone Number

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

5.

Preparer's Mobile Telephone Number (if any)

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

6.

Preparer's Email Address (if any)

Provide the following information about the preparer.

7.a.

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

7.b.

I am an attorney or accredited representative and my
representation of the petitioner in this case
extends
does not extend beyond the
preparation of this petition.

Preparer's Statement

Preparer's Full Name

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

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

2.

Preparer's Business or Organization Name (if any)

Form I-129CW Edition 09/03/21

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.

Page 8 of 12

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

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Preparer's Signature
8.a. Preparer's Signature

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

Form I-129CW Edition 09/03/21

Page 9 of 12

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.

5.b. Part Number

5.c. Item Number

5.d.

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

1.c. Middle Name
2.

A-Number (if any) ► A-

3.a. Page Number

3.d.

4.a. Page Number

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 09/03/21

4.c. Item Number

7.a. Page Number

7.d.

Page 10 of 12

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.

USCIS
Form I-129CW
OMB No. 1615-0111
Expires 09/30/2024

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)

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 (if any)

2.

9.

1.c. Middle Name

Name of Employer/Organization

Male

Female

►

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

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

10.

City or Town of Birth

3.c. Street Number
and Name

11.

State or Province of Birth

12.

Country of Birth

13.

Country of Citizenship or Nationality

3.d.

Apt.

3.e. City or Town
3.f.

State

Ste.

Flr.

3.g. ZIP Code

(USPS ZIP Code Lookup)

Information About the Worker

Worker's Foreign Address (if any)

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 09/03/21

Page 11 of 12

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 10. Additional Information.

►

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 10. Additional
Information.

17.a. Passport or Travel Document Number

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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 (if any)

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

20.

Employment Authorization Document (EAD) Number (if
any)

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

Apt.

26.a. Employer's Name

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

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 10. Additional Information.
23.

Have you ever filed a nonimmigrant petition for this
worker?
Yes
No
If you answered “Yes” to Item Number 23., identify the
classification sought and the receipt number for those
petitions in Part 10. Additional Information.

Form I-129CW Edition 09/03/21

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