Petition For A Nonimmigrant Worker: U.S. Citizenship and Immigration Services
Petition For A Nonimmigrant Worker: U.S. Citizenship and Immigration Services
Petition For A Nonimmigrant Worker: U.S. Citizenship and Immigration Services
Form I-129
Department of Homeland Security OMB No. 1615-0009
U.S. Citizenship and Immigration Services Expires 09/30/2021
In Care Of Name
4. Contact Information
Daytime Telephone Number Mobile Telephone Number Email Address (if any)
9543217430 9543217532 info@highsky.com
5. Other Information
Federal Employer Identification Number (FEIN) Individual IRS Tax Number U.S. Social Security Number (if any)
► 12-1234567 ► ►
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.
e. Extend the status of a nonimmigrant classification based on a free trade agreement. (See Trade Agreement Supplement
to Form I-129 for TN and H-1B1.)
f. Change status to a nonimmigrant classification based on a free trade agreement. (See Trade Agreement Supplement to
Form I-129 for TN and H-1B1.)
5. Total number of workers included in this petition. (See instructions relating to ► 1
when more than one worker can be included.)
Part 3. Beneficiary Information (Information about the beneficiary/beneficiaries you are filing for. Complete the
blocks below. Use the Attachment-1 sheet to name each beneficiary included in this petition.)
1. If an Entertainment Group, Provide the Group Name
N A
3. Provide all other names the beneficiary has used. Include nicknames, aliases, maiden name, and names from all previous marriages.
Family Name (Last Name) Given Name (First Name) Middle Name
N A N A N A
N A N A N A
N A N A N A
4. Other Information
Date of birth (mm/dd/yyyy) Gender U.S. Social Security Number (if any)
09/15/1990 Male Female ►
2. Does each person in this petition have a valid passport? Yes No. If no, go to Part 9. and type or print your
explanation.
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.
5. Are you filing any applications for dependents with this petition?
Yes. If yes, how many? ► 1 No
7. Have you ever filed an immigrant petition for any beneficiary in this petition?
Yes. If yes, how many? ► No
8. Did you indicate you were filing a new petition in Part 2.?
Yes. If yes, answer the questions below. No. If no, proceed to Item Number 9.
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 9. 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 9. and type or print your explanation. No
9. Have you ever previously filed a nonimmigrant petition for this beneficiary?
Yes. If yes, proceed to Part 9. and type or print your explanation. No
10. If you are filing for an entertainment group, has any beneficiary in this petition not been with the group for at least one year?
Yes. If yes, proceed to Part 9. and type or print your explanation. No
11.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 11.b. No
11.b. If you checked yes in Item Number 11.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.
5. Will the beneficiary(ies) work for you off-site at another company or organization's location? Yes No
6. Will the beneficiary(ies) work exclusively in the Commonwealth of the Northern Mariana Islands (CNMI)? Yes No
8. If the answer to Item Number 7. is no, how many hours per week for the position? ►
Vacations.
11. Dates of intended employment From: (mm/dd/yyyy) 08/01/2021 To: (mm/dd/yyyy) 07/31/2024
1. A license is not required from either the U.S. Department of Commerce or the U.S. Department of State to release such
technology or technical data to the foreign person; or
2. A license is required from the U.S. Department of Commerce and/or the U.S. Department of State to release such
technology or technical data to the beneficiary and the petitioner will prevent access to the controlled technology or
technical data by the beneficiary until and unless the petitioner has received the required license or other authorization to
release it to the beneficiary.
Part 7. Declaration, Signature, and Contact Information of Petitioner or Authorized Signatory (Read
the information on penalties in the instructions before completing this section.)
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.
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
Family Name (Last Name) Given Name (First Name)
JHONSON David
Title
President
2. Signature and Date
Signature of Authorized Signatory Date of Signature (mm/dd/yyyy)
06/12/2021
3. Signatory's Contact Information
Daytime Telephone Number Email Address (if any)
9543217430 info@highsky.com
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.
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 Date of Signature (mm/dd/yyyy)
06/12/2021
1. A-Number ► A-
5. Are you seeking advice from USCIS to determine whether changes in the terms or conditions of E status Yes No
for one or more employees are substantive?
Section 1. Information About the Employer Outside the United States (if any)
1. Employer's Name 2. Total Number of Employees
3. Employer's Address
Street Number and Name Apt. Ste. Flr. Number
c. Provide the total number of employees in executive and managerial positions in the United States.
d. Provide the total number of positions in the United States that require persons with special qualifications.
8. If the petitioner is attempting to qualify the employee as an executive or manager, provide the total number of employees he or
she will supervise. Or, if the petitioner is attempting to qualify the employee based on special qualifications, explain why the
special qualifications are essential to the successful or efficient operation of the treaty enterprise.
3. Employer is a (select only one box): 4. If Foreign Employer, Name the Foreign Country
U.S. Employer Foreign Employer
Section 1. Information About Requested Extension or Change (See instructions attached to this form.)
1. This is a request for Free Trade status based on (select only one box):
Section 2. Petitioner's Declaration, Signature, and Contact Information (Read the information on
penalties in the instructions before completing this section.)
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.
I certify, under penalty of perjury, that I have reviewed this petition and that all of the information contained on the petition, including
all responses to specific questions, and in the supporting documents, is complete, true, and correct.
I am filing this petition on behalf of an organization and I certify that I am authorized to do so by the organization.
1. Name of Petitioner
Family Name (Last Name) Given Name (First Name)
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 Date of Signature (mm/dd/yyyy)
Name of the beneficiary or if this petition includes multiple beneficiaries, the total number of beneficiaries
2.a. Name of the Beneficiary
OR
2.b. Provide the total number of beneficiaries
3. List each beneficiary's prior periods of stay in H or L classification in the United States for the last six years (beneficiaries
requesting H-2A or H-2B classification need only list 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
6. Are you filing this petition on behalf of a beneficiary subject to the Guam-CNMI cap exemption under Public Law 110-229?
Yes No
8.a. Does any beneficiary in this petition have ownership interest in the petitioning organization?
Yes. If yes, please explain in Item Number 8.b. No
8.b. Explanation
2. Describe the beneficiary's present occupation and summary of prior work experience.
Statement for H-1B Specialty Occupations and H-1B1 Chile and Singapore
By filing this petition, I agree to, and will abide by, the terms of the labor condition application (LCA) for the duration of the
beneficiary's authorized period of stay for H-1B employment. I certify that I will maintain a valid employer-employee relationship
with the beneficiary at all times. If the beneficiary is assigned to a position in a new location, I will obtain and post an LCA for that
site prior to reassignment.
I further understand that I cannot charge the beneficiary the ACWIA fee, and that any other required reimbursement will be
considered an offset against wages and benefits paid relative to the LCA.
Statement for H-1B Specialty Occupations and U.S. Department of Defense (DOD) Projects
As an authorized official of the employer, I certify that the employer will be liable for the reasonable costs of return transportation of
the alien abroad if the beneficiary is dismissed from employment by the employer before the end of the period of authorized stay.
Signature of Authorized Official of Employer Name of Authorized Official of Employer Date (mm/dd/yyyy)
3. Explain your temporary need for the workers' services (Attach a separate sheet if additional space is needed).
4. List the countries of citizenship for the H-2A or H-2B workers you plan to hire.
5.a. You must provide all of the requested information for Item Numbers 5.a. - 6. for each H-2A or H-2B worker you plan to hire
who is not from a country that has been designated as a participating country in accordance with 8 CFR 214.2(h)(5)(i)(F)(1) or
214.2(h)(6)(i)(E)(1). See www.uscis.gov for the list of participating countries. (Attach a separate sheet if additional space is
needed.)
Family Name (Last Name) Given Name (First Name) Middle Name
6.a. Have any of the workers listed in Item Number 5. above ever been admitted to the United States previously in H-2A/H-2B status?
Yes. If yes, go to Part 9. of Form I-129 and write your explanation. No
7.c. Address
Street Number and Name Apt. Ste. Flr. Number
8.a. Did any of the H-2A/H-2B workers that you are requesting pay you, or an agent, a job placement fee or other form Yes No
of compensation (either direct or indirect) as a condition of the employment, or do they have an agreement to pay
you or the service such fees at a later date? The phrase "fees or other compensation" includes, but is not limited to,
petition fees, attorney fees, recruitment costs, and any other fees that are a condition of a beneficiary's employment
that the employer is prohibited from passing to the H-2A or H-2B worker under law under U.S. Department of
Labor rules. This phrase does not include reasonable travel expenses and certain government-mandated fees (such
as passport fees) that are not prohibited from being passed to the H-2A or H-2B worker by statute, regulations, or
any laws.
8.b. If yes, list the types and amounts of fees that the worker(s) paid or will pay.
8.c. If the workers paid any fee or compensation, were they reimbursed? Yes No
8.d. If the workers agreed to pay a fee that they have not yet been paid, has their agreement been terminated Yes No
before the workers paid the fee? (Submit evidence of termination or reimbursement with this petition.)
9. Have you made reasonable inquiries to determine that to the best of your knowledge the recruiter, Yes No
facilitator, or similar employment service that you used has not collected, and will not collect, directly or
indirectly, any fees or other compensation from the H-2 workers of this petition as a condition of the H-2
workers' employment?
NOTE: If USCIS determines that you knew, or should have known, that the workers requested in
connection with this petition paid any fees or other compensation at any time as a condition of
employment, your petition may be denied or revoked.
10.a. Have you ever had an H-2A or H-2B petition denied or revoked because an employee paid a job placement Yes No
fee or other similar compensation as a condition of the job offer or employment?
10.b. Were the workers reimbursed for such fees and compensation? (Submit evidence of reimbursement.) If Yes No
you answered no because you were unable to locate the workers, include evidence of your efforts to locate
the workers.
12.a. If you are an H-2A petitioner, are you a participant in the E-Verify program? Yes No
The H-2A/H-2B petitioner and each employer consent to allow Government access to the site where the labor is being performed for
the purpose of determining compliance with H-2A/H-2B requirements. The petitioner further 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/H-2B worker fails to report
for work within 5 workdays after the employment start date stated on the petition or, applicable to H-2A petitioners only, within 5
workdays of the start date established by the petitioner, whichever is later; the agricultural labor or services for which H-2A/H-2B
workers were hired is completed more than 30 days early; or the H-2A/H-2B worker absconds from the worksite or is terminated prior
to the completion of agricultural labor or services for which he or she was hired. The petitioner agrees to retain evidence of such
notification and make it available for inspection by DHS officers for a one-year period. "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.
The petitioner must execute Part A. If the petitioner is the employer's agent, the employer must execute Part B. If there are joint
employers, they must each execute Part C.
For H-2A petitioners only: The petitioner agrees to pay $10 in liquidated damages for each instance where it cannot demonstrate it is
in compliance with the notification requirement.
Part A. Petitioner
By filing this petition, I agree to the conditions of H-2A/H-2B employment and agree to the notification requirements. For H-2A
petitioners: I also agree to the liquidated damages requirements defined in 8 CFR 214.2(h)(5)(vi)(B)(3).
Signature of Petitioner Name of Petitioner Date (mm/dd/yyyy)
1. Is the training you intend to provide, or similar training, available in the beneficiary's country? Yes No
2. Will the training benefit the beneficiary in pursuing a career abroad? Yes No
3. Does the training involve productive employment incidental to the training? If yes, explain the Yes No
amount of compensation employment versus the classroom in Part 9. of Form I-129.
4. Does the beneficiary already have skills related to the training? Yes No
6. Do you intend to employ the beneficiary abroad at the end of this training? Yes No
7. If you do not intend to employ the beneficiary abroad at the end of this training, explain why you wish to incur the cost of
providing this training and your expected return from this training.
c. Is the beneficiary an H-1B nonimmigrant exempt from the Department of Labor attestation Yes No
requirements?
c.1. If yes, is it because the beneficiary's annual rate of pay is equal to at least $60,000? Yes No
c.2. Or is it because the beneficiary has a master's degree or higher degree in a specialty related to Yes No
the employment?
d. Does the petitioner employ 50 or more individuals in the United States? Yes No
d.1. If yes, are more than 50 percent of those employees in H-1B, L-1A, or L-1B nonimmigrant Yes No
status?
2. Beneficiary's Highest Level of Education (select only one box)
b. HIGH SCHOOL GRADUATE DIPLOMA or g. Master's degree (for example: MA, MS, MEng, MEd,
the equivalent (for example: GED) MSW, MBA)
c. Some college credit, but less than 1 year h. Professional degree (for example: MD, DDS, DVM, LLB, JD)
d. One or more years of college, no degree i. Doctorate degree (for example: PhD, EdD)
Form I-129 Edition 03/10/21 H-1B and H-1B1 Data Collection and Filing Fee Exemption Supplement Page 19 of 36
Section 2. Fee Exemption and/or Determination (continued)
3. Are you a nonprofit research organization or a governmental research organization, as defined in Yes No
8 CFR 214.2(h)(19)(iii)(C)?
4. Is this the second or subsequent request for an extension of stay that this petitioner has filed for this Yes No
alien?
5. Is this an amended petition that does not contain any request for extensions of stay? Yes No
8. Is the petitioner a nonprofit entity that engages in an established curriculum-related clinical training of Yes No
students registered at such an institution?
If you answered yes to any of the questions above, you are not required to submit the ACWIA fee for your H-1B Form I-129 petition.
If you answered no to all questions, answer Item Number 9. below.
9. Do you currently employ a total of 25 or fewer full-time equivalent employees in the United States, Yes No
including all affiliates or subsidiaries of this company/organization?
If you answered yes, to Item Number 9. above, you are required to pay an additional ACWIA fee of $750. If you answered no, then
you are required to pay an additional ACWIA fee of $1,500.
NOTE: A petitioner seeking initial approval of H-1B nonimmigrant status for a beneficiary, or seeking approval to employ an H-1B
nonimmigrant currently working for another employer, must submit an additional $500 Fraud Prevention and Detection fee. For
petitions filed on or after December 18, 2015, an additional fee of $4,000 must be submitted if you responded yes to Item Numbers
1.d. and 1.d.1. of Section 1. of this supplement. This $4,000 fee was mandated by the provisions of Public Law 114-113.
The Fraud Prevention and Detection Fee and Public Law 114-113 fee do not apply to H-1B1 petitions. These fees, when applicable,
may not be waived. You must include payment of the fees when you submit this form. Failure to submit the fees when required will
result in rejection or denial of your submission. Each of these fees should be paid by separate checks or money orders.
Form I-129 Edition 03/10/21 H-1B and H-1B1 Data Collection and Filing Fee Exemption Supplement Page 20 of 36
Section 3. Numerical Limitation Information (continued)
3. If you answered Item Number 1.d. "CAP Exempt," you must specify the reason(s) this petition is exempt from the numerical
limitation for H-1B classification:
a. The petitioner is an institution of higher education as defined in section 101(a) of the Higher Education Act, of 1965,
20 U.S.C. 1001(a).
b. The petitioner is a nonprofit entity related to or affiliated with an institution of higher education as defined in 8 CFR
214.2(h)(8)(ii)(F)(2).
c. The petitioner is a nonprofit research organization or a governmental research organization as defined in 8 CFR
214.2(h)(8)(ii)(F)(3).
d. The beneficiary will be employed at a qualifying cap exempt institution, organization or entity pursuant to 8 CFR
214.2(h)(8)(ii)(F)(4).
e. The petitioner is requesting an amendment to or extension of stay for the beneficiary's current H-1B classification.
f. The beneficiary of this petition is a J-1 nonimmigrant physician who has received a waiver based on section 214(l)
of the Act.
g. The beneficiary of this petition has been counted against the cap and (1) is applying for the remaining portion of the
6 year period of admission, or (2) is seeking an extension beyond the 6-year limitation based upon sections 104(c) or
106(a) of the American Competitiveness in the Twenty-First Century Act (AC21).
h. The petitioner is an employer subject to the Guam-CNMI cap exemption pursuant to Public Law 110-229.
3. The beneficiary will be paid the higher of the prevailing or actual wage at any and all off-site locations. Yes No
Form I-129 Edition 03/10/21 H-1B and H-1B1 Data Collection and Filing Fee Exemption Supplement Page 21 of 36
L Classification Supplement to Form I-129 USCIS
Form I-129
Department of Homeland Security OMB No. 1615-0009
U.S. Citizenship and Immigration Services Expires 09/30/2021
3. This petition is (select only one box): a. An individual petition b. A blanket petition
4.a. Does the petitioner employ 50 or more individuals in the U.S.? Yes No
4.b. If yes, are more than 50 percent of those employee in H-1B, L-1A, or L-1B nonimmigrant status? Yes No
2. List the beneficiary's and any dependent family member's prior periods of stay in an H or L classification in the United States
for the last seven years. Be sure to list only those periods in which the beneficiary and/or family members were physically
present in the U.S. in an H or L classification. Do not include periods in which the beneficiary was in a dependent status, for
example, H-4 or L-2 status. If more space is needed, go to Part 9. of Form I-129.
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.)
6. Describe the beneficiary's duties abroad for the 3 years preceding the filing of the petition. (If the beneficiary is currently inside the
United States, describe the beneficiary's duties abroad for the 3 years preceding the beneficiary's admission to the United States.)
9. How is the U.S. company related to the company abroad? (select only one box)
a. Parent b. Branch c. Subsidiary d. Affiliate e. Joint Venture
11. Do the companies currently have the same qualifying relationship as they did during the one-year period of the alien's
employment with the company abroad?
Yes No. If no, provide an explanation in Part 9. of Form I-129 that the U.S. company has and will have a qualifying
relationship with another foreign entity during the full period of the requested period of stay.
12. Is the beneficiary coming to the United States to open a new office?
Yes No (attach explanation)
If you are seeking L-1B specialized knowledge status for an individual, answer the following question:
13.a. Will the beneficiary be stationed primarily offsite (at the worksite of an employer other than the petitioner or its affiliate,
subsidiary, or parent)?
Yes No
13.b. If you answered yes to the preceding question, describe how and by whom the beneficiary's work will be controlled and
supervised. Include a description of the amount of time each supervisor is expected to control and supervise the work. If you
need additional space to respond to this question, proceed to Part 9. of the Form I-129, and type or print your explanation.
13.c. If you answered yes to the preceding question, describe the reasons why placement at another worksite outside the petitioner,
subsidiary, affiliate, or parent is needed. Include a description of how the beneficiary's duties at another worksite relate to the
need for the specialized knowledge he or she possesses. If you need additional space to respond to this question, proceed to
Part 9. of the Form I-129, and type or print your explanation.
Name of the Beneficiary or if this petition includes multiple beneficiaries, the total number of beneficiaries included.
2.a. Name of the Beneficiary
Daniel Jose NAVARRETE
OR
6. If filing for an O-2 or P support classification, list dates of the beneficiary's prior work experience under the principal O-1 or P alien.
N/A
7.a. Does any beneficiary in this petition have ownership interest in the petitioning organization?
If no, provide the following information about the organization(s) to which you have sent a duplicate of this petition.
O-1 Extraordinary Ability
10.a. Name of Recognized Peer/Peer Group or Labor Organization
Section 1. Complete if you are filing for a Q-1 International Cultural Exchange Alien
I hereby certify that the participant(s) in the international cultural exchange program:
a. Is at least 18 years of age,
b. Is qualified to perform the service or labor or receive the type of training stated in the petition,
c. Has the ability to communicate effectively about the cultural attributes of his or her country of nationality to the American
public, and
d. Has resided and been physically present outside the United States for the immediate prior year. (Applies only if the
participant was previously admitted as a Q-1).
I also certify that I will offer the alien(s) the same wages and working conditions comparable to those accorded local domestic
workers similarly employed.
1. Name of Petitioner
Family Name (Last Name) Given Name (First Name) Middle Name
Section 1. Complete This Section If You Are Filing For An R-1 Religious Worker
Employer Attestation
1.b. Number of employees working at the same location where the beneficiary will be employed?
1.c. Number of aliens holding special immigrant or nonimmigrant religious worker status currently
employed or employed within the past five years?
1.d. Number of special immigrant religious worker petition(s) (I-360) and nonimmigrant religious
worker petition(s) (I-129) filed by the petitioner within the past five years?
2. Has the beneficiary or any of the beneficiary's dependent family members previously been admitted Yes No
to the United States for a period of stay in the R visa classification in the last five years?
If yes, complete the spaces below. List the beneficiary and any dependent family member’s prior periods of stay in the R visa
classification in the United States in the last five years. Please be sure to list only those periods in which the beneficiary and/or
family members were actually in the United States in an R classification.
NOTE: Submit photocopies of Forms I-94 (Arrival-Departure Record), I-797 (Notice of Action), and/or other USCIS
documents identifying these periods of stay in the R visa classification(s). If more space is needed, provide the information in
Part 9. of Form I-129.
4. Describe the relationship, if any, between the religious organization in the United States and the organization abroad of which
the beneficiary is a member.
5.d. Description of the proposed salaried compensation or non-salaried compensation. If the beneficiary will be self-supporting, the
petitioner must submit documentation establishing that the position the beneficiary will hold is part of an established program
for temporary, uncompensated missionary work, which is part of a broader international program of missionary work sponsored
by the denomination.
Petitioner Attestations
Does the petitioner attest to all of the requirements described in Item Numbers 6. - 12. below?
6. The petitioner is a bona fide non-profit religious organization or a bona fide organization that is affiliated with the religious
denomination and is tax-exempt as described in section 501(c)(3) of the Internal Revenue Code of 1986, subsequent
amendment, or equivalent sections of prior enactments of the Internal Revenue Code. If the petitioner is affiliated with the
religious denomination, complete the Religious Denomination Certification included in this supplement.
Yes No. If no, type or print your explanation below and if needed, go to Part 9. of Form I-129.
7. The petitioner is willing and able to provide salaried or non-salaried compensation to the beneficiary. If the beneficiary will be
self-supporting, the petitioner must submit documentation establishing that the position the beneficiary will hold is part of an
established program for temporary, uncompensated missionary work, which is part of a broader international program of
missionary work sponsored by the denomination.
Yes No. If no, type or print your explanation below and if needed, go to Part 9. of Form I-129.
8. If the beneficiary worked in the United States in an R-1 status during the 2 years immediately before the petition was filed, the
beneficiary received verifiable salaried or non-salaried compensation, or provided uncompensated self-support.
Yes No. If no, type or print your explanation below and if needed, go to Part 9. of Form I-129.
9. If the position is not a religious vocation, the beneficiary will not engage in secular employment, and the petitioner will provide
salaried or non-salaried compensation. If the position is a traditionally uncompensated and not a religious vocation, the
beneficiary will not engage in secular employment, and the beneficiary will provide self-support.
Yes No. If no, type or print your explanation below and if needed, go to Part 9. of Form I-129.
11. The beneficiary has been a member of the petitioner's denomination for at least two years immediately before Form I-129 was
filed and is otherwise qualified to perform the duties of the offered position.
Yes No. If no, type or print your explanation below and if needed, go to Part 9. of Form I-129.
12. The petitioner will notify USCIS within 14 days if an R-1 alien is working less than the required number of hours or has been
released from or has otherwise terminated employment before the expiration of a period of authorized R-1 stay.
Yes No. If no, type or print your explanation below and if needed, go to Part 9. of Form I-129.
Attestation
I certify, under penalty of perjury, that the contents of this attestation and the evidence submitted with it are true and correct.
Name of Petitioner Title
Employer or Organization Address (do not use a post office or private mail box)
Street Number and Name Apt. Ste. Flr. Number
Section 2. This Section Is Required For Petitioners Affiliated With The Religious Denomination
Religious Denomination Certification
I certify, under penalty of perjury, that:
Name of Employing Organization
is affiliated with:
Name of Religious Denomination
and that the attesting organization within the religious denomination is tax-exempt as described in section 501(c)(3) of the Internal
Revenue Code of 1986 (codified at 26 U.S.C. 501(c)(3)), any subsequent amendment(s), subsequent amendment, or equivalent
sections of prior enactments of the Internal Revenue Code. The contents of this certification are true and correct to the best of my
knowledge.
Attesting Organization Name and Address (do not use a post office or private mail box)
Attesting Organization Name
Date of birth (mm/dd/yyyy) Gender U.S. Social Security Number (if any) A-Number (if any)
Male Female ► A-
All Other Names Used (include aliases, maiden name and names from previous marriages)
Family Name (Last Name) Given Name (First Name) Middle Name
Address in the United States Where You Intend to Live (Complete Address)
Street Number and Name Apt. Ste. Flr. Number
Date Passport or Travel Document Date Passport or Travel Document Country of Issuance for Passport
Issued (mm/dd/yyyy) Expires (mm/dd/yyyy) or Travel Document
Student and Exchange Visitor Information System (SEVIS) Number Employment Authorization Document (EAD) Number
(if any) (if any)
Date of birth (mm/dd/yyyy) Gender U.S. Social Security Number (if any) A-Number (if any)
Male Female ► A-
All Other Names Used (include aliases, maiden name and names from previous Marriages)
Family Name (Last Name) Given Name (First Name) Middle Name
Address in the United States Where You Intend to Live (Complete Address)
Street Number and Name Apt. Ste. Flr. Number
Date Passport or Travel Document Date Passport or Travel Document Country of Issuance for Passport
Issued (mm/dd/yyyy) Expires (mm/dd/yyyy) or Travel Document
Student and Exchange Visitor Information System (SEVIS) Number Employment Authorization Document (EAD) Number
(if any) (if any)