Form I-129H2A (PDFi) I-129H2A (PDFi) Petition for Nonimmigrant Worker: H-2A Classification

Petition for a Nonimmigrant Worker: H-2A Classification

USCIS
Form I-129H2A

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

OMB No. 1615-0009
Expires 12/31/2027

Partial Approval (explain)

Receipt

Action Block

For
USCIS
Use
Only
Class:
No. of Workers:
Job Code:
Validity Dates:
From:
To:

Classification Approved
Consulate/POE/PFI Notified
At:

Extension Granted
COS/Extension Granted

► START HERE - Type or print in black ink.

Part 1. Petitioner Information
If you are an individual filing this petition, complete Item Number 1. If you are a company or an organization filing this petition,
complete Item Number 2.
1.

Legal Name of Individual Petitioner
Family Name (Last Name)

Given Name (First Name)

2.

Company or Organization Name

3.

Mailing Address of Individual, Company or Organization

Middle Name

(USPS ZIP Code Lookup)

In Care Of Name

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

4.

Postal Code

ZIP Code

Country

Contact Information
Daytime Telephone Number

Mobile Telephone Number

Email Address (if any)

Other Information
5.

Federal Employer Identification Number (FEIN)
►

6.

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

7.

Individual IRS Tax Number
►

Form I-129H2A Edition 09/17/25

8.

Yes

No

U.S. Social Security Number (if any)
►
Page 1 of 14

Part 2. Information About This Petition
1.

Type of Beneficiaries Requested (select only one box):
Named

2.

Unnamed

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 13. Additional Information About
Your Petition).

d. New concurrent employment.
e.

Change of employer for beneficiary(ies) already in the requested classification.

f.

Amended petition (provide an explanation in Part 13. Additional Information About Your Petition).

3.

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

4.

Requested Action (select only one box):
a.

►

Notify the office in Item Number 6. so each beneficiary can obtain a visa or be admitted.

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 instructions for limitations). This is available only when you check "New Employment" in Item
Number 2., 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 and is/are not seeking
additional time from the current authorized period of stay.
►

5.

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

6.

If a beneficiary or beneficiaries is/are outside the United States, or a requested extension of stay or change of status cannot be
granted, state the U.S. Consulate or inspection facility you want notified if this petition is approved.
a. Type of Office (select only one box):
b. Office Address (City)

Consulate

Pre-flight inspection

Port of Entry

c. U.S. State or Foreign Country

If you are filing for unnamed beneficiaries, skip Part 3. and Part 4. and go directly to Part 5. Basic Information About the
Proposed Employment and Employer.

Part 3. Beneficiary Information (Information about the beneficiary/beneficiaries you are filing for.
Complete the blocks below only if you are filing for named beneficiaries. Use the Attachment-1 sheet to name
each additional beneficiary included in this petition.)
1.

Provide Name of Beneficiary
Family Name (Last Name)

2.

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.
Family Name (Last Name)

Form I-129H2A Edition 09/17/25

Given Name (First Name)

Middle Name

Page 2 of 14

Part 3. Beneficiary Information (Information about the beneficiary/beneficiaries you are filing for.
Complete the blocks below only if you are filing for named beneficiaries. Use the Attachment-1 sheet to
name each additional beneficiary included in this petition.) (continued)
Other Information
3.

Date of birth (mm/dd/yyyy)

4.

Sex
Male

6.

5.

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

Female

Alien Registration Number (A-Number)
► A-

7.

Country of Birth

Province of Birth

8.

Country of Citizenship or Nationality

9.

If the beneficiary is in the United States, complete the following:
Date of Last Arrival (mm/dd/yyyy) I-94 Arrival-Departure Record Number
►
Date Passport or Travel Document
Issued (mm/dd/yyyy)

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

Current Nonimmigrant Status

Date Status Expires (mm/dd/yyyy) or D/S

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

10.

11.

Passport or Travel Document Number

Employment Authorization Document (EAD)
Number (if any)

Current Residential U.S. Address (if applicable) (do not list a P.O. Box)
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

ZIP Code

Beneficiary's Foreign Address
Street Number and Name

Apt. Ste. Flr. Number

City or Town

Province

Form I-129H2A Edition 09/17/25

State

Postal Code

Country

Page 3 of 14

Part 4. Processing Information (Complete the blocks below only if you are filing for named beneficiaries.)
1.

Does each person in this petition have a valid passport?

2.

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

Yes

No. If "No," go to Part 13. and type or print your
explanation.

No

3.

Are you filing any applications for dependents with this petition?
Yes. If "Yes," how many? ►
No

4.

Are you filing any applications for replacement/initial I-94, Arrival-Departure Records with this petition? Note that if the
beneficiary was issued an electronic Form I-94 by CBP when he/she was admitted to the United States at an air or sea port, he/
she may be able to obtain the Form I-94 from the CBP Website at www.cbp.gov/i94 instead of filing an application for a
replacement/initial I-94.
Yes. If "Yes," how many? ►

5.

No

Is any beneficiary in this petition in removal proceedings?
Yes. If "Yes," proceed to Part 13. and list the beneficiary's(ies) name(s).

6.

Have you ever filed an immigrant petition for any beneficiary in this petition?
Yes. If "Yes," how many? ►
No

7.

Did you indicate you were filing a new petition in Part 2.?
Yes. If "Yes," answer the questions below.

8.

No

No. If "No," proceed to Item Number 8.

a.

Has any beneficiary in this petition ever been given the classification you are now requesting within the last seven years?
Yes. If "Yes," proceed to Part 13. and type or print your explanation.
No

b.

Has any beneficiary in this petition ever been denied the classification you are now requesting within the last seven years?
Yes. If "Yes," proceed to Part 13. and type or print your explanation.
No

Have you ever previously filed a nonimmigrant petition for this beneficiary?
Yes. If "Yes," proceed to Part 13. and type or print your explanation.

No

9.a. Has any beneficiary in this petition ever been a J-1 exchange visitor or J-2 dependent of a J-1 exchange visitor?
Yes. If "Yes," proceed to Item Number 9.b.
No
9.b. If you checked "Yes" in Item Number 9.a., provide the dates the beneficiary 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.

10.

List each beneficiary's prior periods of stay in H or L classification for the last three years. Be sure to only list those periods in
which each 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.
NOTE: Submit photocopies of Forms I-94, I-797, and/or other USCIS issued documents noting these periods of stay in the H
or L classification. (If more space is needed, attach an additional sheet.)
Period of Stay (mm/dd/yyyy)
Subject's Name
From
To

Form I-129H2A Edition 09/17/25

Page 4 of 14

Part 4. Processing Information (Complete the blocks below only if you are filing for named beneficiaries.)
(continued)
11.

Have any of the beneficiaries individuals ever been admitted to the United States previously in H-2A/H-2B status?
Yes. If "Yes," go to Part 13. of Form I-129 and write your explanation.

12.

No

Are you requesting a restarting of the 3-year maximum period of stay limit in H-2A status for any of your
named beneficiaries because they were absent from the United States for an uninterrupted period of at least
60 days? (See form Instructions for more information on “Period of Absence.”)

Yes

No

If you answered “Yes” to Item Number 12., you must document the beneficiaries' periods of stay for the last 3 years in Item
Number 10. You must also submit evidence of each entry and each exit to establish each period of absence.

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

Job Title

2. ETA Case Number

3.

Address(es) where the beneficiary(ies) will work if different from address in Part 1. If you need to provide more than two
additional addresses, use Part 13. Additional Information About Your Petition.
Address 1
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

ZIP Code

Is this a third-party location?

Yes

No

Yes

No

If you answered "Yes," provide the name of the third-party organization.

Address 2
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

ZIP Code

Is this a third-party location?
If you answered "Yes," provide the name of the third-party organization.

4.

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

Yes

No

5.

Is this a full-time position?

Yes

No

6.

If the answer to Item Number 5. is "No," how many hours per week for the position?

►

7.

Wages:

►

$

Form I-129H2A Edition 09/17/25

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

Page 5 of 14

Part 5. Basic Information About the Proposed Employment and Employer (continued)
8.

Other Compensation (Explain)

9.

Dates of intended employment From: (mm/dd/yyyy)

10.

Type of Business

12.

Current Number of Employees in the United States

13.

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?

14.

Gross Annual Income
$

16.

Nature of employment is:

To: (mm/dd/yyyy)
11.

15.

Year Established

Yes

No

Yes

No

Net Annual Income
$

a. Seasonal

b. Temporary

Explain your temporary need for the workers' services (Attach a separate sheet if additional space is needed).

17.

Did you or do you plan to use an agent, facilitator, staff, recruiter, or similar employment service (any
person or entity that recruits or solicits prospective beneficiaries of the H-2 petition) to locate and/or recruit
the H-2A workers that you intend to hire by filing this petition?

18.

If you answered “Yes,” to Item Number 17., list the name and address(es) of all such persons and entities regardless of whether
you have a direct or indirect contractual relationship, and whether such person or entity is located inside or outside the United
States or is a governmental or quasi-governmental entity. If you need to include the name and address of more than one person
or entity, use the space provided in Part 13. Additional Information About Your Petition.
Name of Recruiter, Agent, or Facilitator
Family Name (Last Name)

Given Name (First Name)

Middle Name

Name of Recruiting Organization or Similar Employment Service (if applicable)

Address of Agent, Facilitator, Recruiter, or Similar Employment Service
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Form I-129H2A Edition 09/17/25

ZIP Code

Page 6 of 14

Part 6. Prohibited Fees
For Item Numbers 1. - 6., the fees in question include any job placement fee, fee or penalty for breach of contract, or other fee, penalty, or
compensation (either direct or indirect), related to the H-2A employment. Such prohibited fees may include, but are not limited to withholdings
or deductions from a worker's wages. Your responses to these items pertain to anyone associated with the employment or recruitment, including
any joint employers. Your responses to these items also pertain to any person or entity to whom you can be considered a successor in interest.
NOTE: It is not prohibited for petitioners (including their employees), employers or any joint employers, agents, attorneys, facilitators, recruiters,
or similar employment services from receiving reimbursement from the beneficiary for costs that are the responsibility and primarily for the benefit
of the worker, such as government-required passport fees. Furthermore, it is not prohibited for an employer to provide reimbursement for fees or
expenses incurred by the worker, where such reimbursement is specifically permitted by, and made in compliance with, statute or regulations.
1.

Did any of the H-2A workers that you are requesting pay you or your employee(s), or any employer or joint
employer, agent, attorney, facilitator, recruiter, or similar employment service, a prohibited fee related to
the employment, or do they have an agreement to pay you such fee at a later date?

2.

If you answered “Yes” to Item Number 1., list the types and amounts of fees that the worker(s) paid or will pay.

3.

If you answered “Yes” to Item Number 1., were the workers, or their designee (as appropriate),
reimbursed for any fee paid and was any agreement to pay a fee terminated?

Yes

No

Yes

No

If you answered “Yes” to Item Number 3., submit evidence of full reimbursement of each affected beneficiary, or the
beneficiary's designee (as appropriate), and evidence that any agreement has been terminated.
4.

If you answered “Yes” to Item Number 1., are you requesting an exception to the mandatory denial or
revocation for prohibited fees (see form Instructions for information about exceptions)?

Yes

No

If you answered “Yes” to Item Number 4., submit evidence supporting your request for an exception, as described in the form Instructions.
5.

Within the last four years, have you ever had an H-2A or H-2B petition denied or revoked because an
employee paid or agreed to pay a fee related to the employment or have you withdrawn an H-2A or H-2B
petition after USCIS issued a notice of intent to deny or revoke on such basis?

Yes

No

If you answered “Yes” to Item Number 5., submit a copy of the USCIS notice(s) of denial, revocation, or acknowledgment of
your withdrawal.
6.

If you answered “Yes” to Item Number 5., were the workers, or their designees (as appropriate),
reimbursed for any fees paid and was any agreement to pay a fee terminated?

Yes

No

If you answered “Yes” to Item Number 6., submit evidence of full reimbursement of each affected beneficiary, or the
beneficiary's designee (as appropriate), and evidence that any agreement has been terminated.

Part 7. Other Violations
For Item Numbers 1. - 6., determinations of violations include those against you (the petitioner), any person or entity to which you
are a successor in interest, or any individual who was acting on your behalf. For Item Number 2., Item Number 4., and Item
Number 6., determinations of violations also include those against any employee who an H-2A or H-2B worker would reasonably
believe is acting on your behalf. See the form Instructions for information about how USCIS will use your responses in
adjudicating your H-2A petition.
1.

Are you currently subject to any debarment order by the U.S. Department of Labor (or, if applicable, the
Governor of Guam)?

Yes

No

If you answered “Yes” to Item Number 1., you must submit a complete copy of the final notice of debarment or administrative
determination(s).
2.

Within the last 3 years, have you had an approved temporary labor certification revoked by the U.S.
Department of Labor (or, if applicable, the Guam Department of Labor) or have you been the subject of
any administrative sanction or remedy, including a debarment that has concluded or an assessment of civil
money penalties?

Yes

No

If you answered “Yes” to Item Number 2., you must submit a complete copy of the final administrative determination(s).
Form I-129H2A Edition 09/17/25

Page 7 of 14

Part 7. Other Violations (continued)
3.

Within the last 3 years, have you been the subject of a final USCIS denial or revocation decision with
respect to a prior H-2A or H-2B petition that included a finding of fraud or willful misrepresentation of a
material fact? (A final USCIS denial or revocation decision means that there is no pending administrative
appeal or that the time for filing a timely administrative appeal has elapsed.)

Yes

No

Yes

No

Yes

No

If you answered “Yes” to Item Number 3., you must submit a complete copy of the final USCIS decision(s).
4.

Within the last 3 years, have you been the subject of a final USCIS decision revoking the approval of a
prior petition that includes one or more of the following findings: the beneficiary was not employed by the
petitioner in the capacity specified in the petition; the statement of facts contained in the petition or on the
application for a temporary labor certification was not true and correct, or was inaccurate; the petitioner
violated terms and conditions of the approved petition; or the petitioner violated requirements of the
Immigration and Nationality Act (INA) section 101(a)(15)(H) or paragraph (h) of this section? (A final
USCIS denial or revocation decision means that there is no pending administrative appeal or that the time
for filing a timely administrative appeal has elapsed.)
If you answered “Yes” to Item Number 4., you must submit a complete copy of the final USCIS decision(s).

5.

Within the last 3 years, have you been the subject of a final determination of violation(s) under INA section
274(a), 8 U.S.C. 1324(a)? (“Bringing in and Harboring Certain Aliens,” “Criminal Penalties.”)

If you answered “Yes” to Item Number 5., you must submit a complete copy of the final determination of violation(s).
6.

Within the last 3 years, have you been the subject of any final administrative or judicial determination,
other than ones described in Item Numbers 1. - 5. above, finding a violation of any applicable
employment-related laws or regulations, including health and safety laws or regulations?

Yes

No

If you answered “Yes” to Item Number 6., you must submit a complete copy of the final administrative or judicial determination(s).

Part 8. Petition and Employer Obligations
1.

The H-2A petitioner and each employer consent to allow Government access to all sites where the labor is
being or will be performed, as well as housing sites for the purpose of determining compliance with H-2A
requirements. The petitioner and each employer agree to allow USCIS to conduct interviews of employees
and any other individuals possessing pertinent information, which may be conducted in the absence of the
employer or the employer's representatives and, if feasible, at a neutral location agreed to by the employee and
USCIS. The petitioner and each employer understand that USCIS's inability to verify facts, including due to
the failure or refusal of the petitioner or employer to cooperate in an inspection or other compliance review,
may result in denial or revocation of the H-2A petition.

Yes

No

2.

The petitioner agrees to notify DHS beginning on a date and in a manner specified in a notice published in
the Federal Register within 2 workdays if: an H-2A worker does not report for work within 5 workdays
after the employment start date stated on the petition or within 5 workdays of the start date established by
the petitioner, whichever is later; the agricultural labor or services for which H-2A workers were hired is
completed more than 30 days early; or the H-2A worker does not report for work for a period of 5
consecutive workdays without the consent of the employer or is terminated prior to the completion of
agricultural labor or services for which he or she was hired.

Yes

No

See www.uscis.gov/h-2a for the appropriate manner of notifying DHS as specified in a notice published in the Federal Register.
NOTE: The above notification is a petitioner obligation and does not represent an indication of wrongdoing on the part of the
worker. Further, USCIS does not consider the information provided in a petitioner notification, alone, to be conclusive evidence
regarding the worker's current status. “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.
3.

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

4.

The petitioner agrees to pay $10 in liquidated damages for each instance where it cannot demonstrate it is
in compliance with the notification requirement.

Yes

No

Form I-129H2A Edition 09/17/25

Page 8 of 14

Part 9. Declaration, Signature, and Contact Information of Petitioner or Authorized Signatory (Read
the information on penalties in the instructions before completing this section.)
By filing this petition, I agree to the conditions of H-2A employment, agree to fully cooperate with any compliance review,
evaluation, verification, or inspection conducted by USCIS, and agree to the notification requirements. I also agree to the liquidated
damages requirements defined in 8 CFR 214.2(h)(5)(vi)(B)(3).
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 U.S. Citizenship and Immigration Services (USCIS) at a later date.
I authorize the release of any information from my records, or from the petitioning organization's records that USCIS needs to
determine eligibility for the immigration benefit sought. 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.
As only applicable for petitions filed prior to approval of the temporary labor certification, I recognize that USCIS will make any
necessary modifications to this petition after submission to reflect any modifications made by the Department of Labor to the
temporary labor certification.
If I have selected this box, I am certifying that I have received a notice of acceptance from the Department of Labor for the
ETA Case Number identified in Part 5., Item Number 2. and am not required to submit the temporary labor certification
at the time of filing.
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 and that all of the information contained in the petition, including
all responses to specific questions, and in the supporting documents, is complete, true, and correct.
1.

Name and Title of Authorized Signatory
Given Name (First Name)

Family Name (Last Name)

Title

2.

Signature and Date
Signature of Authorized Signatory

3.

Date of Signature (mm/dd/yyyy)

Signatory's Contact Information
Daytime Telephone Number

Email Address (if any)

NOTE: If you do not fully complete this form or fail to submit the required documents listed in the instructions, a final decision on
your petition may be delayed or the petition may be denied.

Part 10. Certification and Signature of 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-2A eligibility. I agree to fully cooperate with any
compliance review, evaluation, verification, or inspection conducted by USCIS.
1.

Name of Employer

2.

Signature of Employer

Form I-129H2A Edition 09/17/25

Date of Signature (mm/dd/yyyy)

Page 9 of 14

Part 11. Certification and Signature of Joint Employer
A separate Part 11. must be submitted for each Joint Employer.
1.

Legal Name of Individual Joint Employer
Family Name (Last Name)

Given Name (First Name)

2.

Joint Employer Company or Organization Name

3.

Mailing Address of Joint Employer

Middle Name

In Care Of Name (if any)

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

4.

Postal Code

ZIP Code

Country

Contact Information
Daytime Telephone Number

Mobile Telephone Number

Email Address (if any)

Taxpayer Identification Numbers
5.

Provide the following information, as applicable.
Employer Identification Number (EIN) Individual Taxpayer Identification Number
►
(ITIN) ►

U.S. Social Security Number (SSN)
►

Other Information
6.

Type of Business Activity(ies)

Year Established

Current Number of Employees in the United States

Gross Annual Income
$

Net Annual Income
$

Joint Employer's Certification
I agree to the conditions of H-2A eligibility employment, and agree to fully cooperate with any compliance review, evaluation,
verification, or inspection conducted by USCIS.
7.

Family Name (Last Name) of Authorized Signatory

Given Name (First Name) of Authorized Signatory

Title of Authorized Signatory

8.

Signature of Authorized Signatory

Form I-129H2A Edition 09/17/25

Date of Signature (mm/dd/yyyy)

Page 10 of 14

Part 12. Declaration, Signature, and Contact Information of Person Preparing Form, If Other Than
Petitioner
1.

Name of Preparer
Family Name (Last Name)

Given Name (First Name)

Provide the following information concerning the preparer:
2.

Preparer's Business or Organization Name (if any)
(If applicable, provide the name of your accredited organization recognized by the Board of Immigration Appeals (BIA)).

3.

Preparer's Mailing Address
Street Number and Name

Apt. Ste. Flr.

Number

City or Town

State

ZIP Code

Province

4.

Postal Code

Country

Preparer's Contact Information
Daytime Telephone Number

Fax Number

Email Address (if any)

Preparer's Declaration
By my signature, I certify, swear, or affirm, under penalty of perjury, that I prepared this petition on behalf of, at the request of, and
with the express consent of the petitioner or authorized signatory. The petitioner has reviewed this completed petition as prepared by
me and informed me that all of the information in the form and in the supporting documents, is complete, true, and correct.
5.

Signature and Date
Signature of Preparer

Form I-129H2A Edition 09/17/25

Date of Signature (mm/dd/yyyy)

Page 11 of 14

Part 13. Additional Information About Your Petition
If you require more space to provide any additional information within this petition, use the space below. If you require more space
than what is provided to complete this petition, you may make a copy of Part 13. to complete and file with this petition. In order to
assist us in reviewing your response, you must identify the Page Number, Part Number and Item Number corresponding to the
additional information.
1.

Individual Petitioner or Company Name (same as Part 1.)

2.

Page Number

Part Number

Item Number

3.

Page Number

Part Number

Item Number

4.

Page Number

Part Number

Item Number

Form I-129H2A Edition 09/17/25

Page 12 of 14

H-2A Named Beneficiary Attachment
Attach to Form I-129H2A when more than one person is included in the petition.
Complete a separate copy of this attachment for each additional named beneficiary included in this petition.
Do not include the person named in Part 3. of Form I-129H2A
1.

Name of Beneficiary
Family Name (Last Name)

2.

Given Name (First Name)

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

3.

Middle Name

Given Name (First Name)

Middle Name

Other Information
Date of birth (mm/dd/yyyy)

Sex
Male

Alien Registration Number (A-Number)

Female

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

Country of Birth

► AProvince of Birth

4.

Country of Citizenship or Nationality

IF IN THE UNITED STATES:
Date of Last Arrival (mm/dd/yyyy) I-94 Arrival-Departure Record Number

Passport or Travel Document Number

Date Passport or Travel Document Date Passport or Travel Document Country of Issuance for Passport or
Issued (mm/dd/yyyy)
Expires (mm/dd/yyyy)
Travel Document

5.

Current Nonimmigrant Status

Date Status Expires (mm/dd/yyyy) or D/S

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

Employment Authorization Document (EAD) Number
(if any)

Address in the United States Where You Intend the Beneficiary to Live (Complete Address)
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Form I-129H2A Edition 09/17/25

ZIP Code

Page 13 of 14

H-2A Named Beneficiary Attachment
Attach to Form I-129H2A when more than one person is included in the petition.
Complete a separate copy of this attachment for each additional named beneficiary included in this petition.
Do not include the person named in Part 3. of Form I-129H2A (continued)
6.

Foreign Address (Complete Address)
Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

Form I-129H2A Edition 09/17/25

Postal Code

ZIP Code

Country

Page 14 of 14