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Previous Petition Receipt Number *
IRS Employer Identification Number (if any)
USCIS Online Account Number (if any)
U.S. Social Security Number (if any)
Company or Organization Name
City/Town/Village of Birth *
Mailing Address: In Care of
Country *
Alien Registration Number (A-Number) (if any)
U.S. Social Security Number (if any)
City/Town/Village of Birth *
Country of Birth *
Country of Citizenship or Nationality *
Alien's Current County of Residence or if now in the United States, provide the last country of permanent residence abroad.
Person 1's Country of Birth:
Person 1's Relationship
Person 2's Relationship
Person 2's Country of Birth
Person 3's Relationship
Person 3's Country of Birth
Person 4's Relationship
Person 4's Country of Birth
Relationship
Country of Birth
Person 6's Relationship
Person 6's Country of Birth
Form I-94 Arrival-Departure Record Number
Date authorized stay expired, or will expire, as shown on Form I-94 or Form I-95 (mm/dd/yyyy) or type "D/S" for Duration of Status
Status on Form I-94 (for example Class of Admission, or Paroled, if paroled.)
Passport Number
Travel Document Number
Country of Issuance for Passport or Travel Document
City or Town *
Country *
Provide the Case Number, Office Location, Date of Decision, and Disposition of the Decision *
Since you selected other, please enter the Other form(s): *
Provide the Case Number, Office Location, Date of Decision, and Disposition of the Decision *
Provide the Case Number, Office Location, Date of Decision, and Disposition of the Decision *
Provide the Case Number, Office Location, Date of Decision, and Disposition of the Decision *
Provide the Case Number, Office Location, Date of Decision, and Disposition of the Decision *
Please enter your answer for "Other" *
Type of Business
Current Number of Employees
Gross Annual Income $
Net Annual Income $
NAICS Code
Labor Certification DOL Case Number
Occupation
Annual Income
Job Title *
SOC Code xx-xxxx *
Nontechnical Job Description *
How many hours per week for the position? *
Wages (Specify hour, week, month, or year) $ *
What is the language in which you are fluent? *
Preparer Business or Organization Name (if any)
Preparer's Daytime Phone Number *
Preparer's Mobile Phone Number
Preparer's Email Address *
Interpreter Business or Organization Name (if any)
Interpreter's Daytime Phone Number *
Interpreter's Mobile Phone Number
Interpreter's Email Address
I, the interpreter, certify under penalty of perjury, that I am fluent in English and: (Must be same language that you interpreted for the Petitioner)
Authorized Signatory's Title
Authorized Signatory's Daytime Phone Number
Authorized Signatory's Mobile Phone Number
Authorized Signatory's Email
