Nonimmigrant Petition Based on Blanket L Petition Department of Homeland Security U.S. Citizenship and Immigration Services For Government Use Only Received Relocated Sent Resubmitted Relocated Received Fee Receipt Action Block OMB No. 1615-0010 Expires 06/30/2018 USCIS Form I-129S Validity Dates From: To: Denial Reason Beneficiary Interviewed on: Approved as: Manager/Executive Specialized Knowledge Professional Approval Date: To be completed by an attorney or accredited representative (if any). Select this box if Form G-28 is attached. Attorney State Bar Number (if applicable) Attorney or Accredited Representative USCIS Online Account Number (if any) START HERE - Type or print in black ink. Part 1. Information About The Employer (Petitioner) 1. Name of the Petitioner Petitioner's Physical Address 4.a. Street Number and Name 4.b. Apt. Ste. Flr. Petitioner's Mailing Address 2.a. In Care Of Name (if any) 2.b. Street Number and Name 2.c. Apt. Ste. Flr. 4.c. City or Town 4.d. State 4.e. ZIP Code Petitioner's Contact Information 5. 6. 2.f. ZIP Code 7. 8. Daytime Telephone Number Fax Number Email Address (if any) Web site Address (if any) 2.d. City or Town 2.e. State 3. Is this mailing address the same as the physical location of the sponsoring company or organization? Yes No If you answered "No" to Item Number 3., provide the sponsoring company's or organization's physical address in Item Numbers 4.a. - 4.e. Petitioner's Employees in the United States 9. Does the petitioner employ 50 or more individuals in the United States? Yes No If you answered "Yes" to Item Number 9., complete Item Number 10. 10. Are more than 50 percent of the petitioner's employees in H-1B, L-1A, or L-1B nonimmigrant status? Yes No Page 1 of 8 American LegalNet, Inc. www.FormsWorkFlow.com Form I-129S 06/02/16 N Part 2. Information About the Proposed Position and Prior Employment Periods in the United States The beneficiary will work as a: 1.a. 1.b. Manager or Executive (L-1A) Specialized Knowledge Professional (L-1B) Beneficiary's Full Name 4.a. Family Name (Last Name) 4.b. Given Name (First Name) 4.c. Middle Name Other Names Used List all other names the beneficiary has ever used, including aliases, maiden name, and names from all previous marriages. If you need extra space to complete this section, use the space provided in Part 10. Additional Information. 5.a. Family Name (Last Name) 5.b. Given Name (First Name) 5.c. Middle Name Dates of Proposed Employment Provide the beneficiary's dates of proposed employment. 2.a. Start Date (mm/dd/yyyy) 2.b. End Date (mm/dd/yyyy) Prior Periods of Stay in the United States If the beneficiary was previously in the United States, provide the dates of the beneficiary's prior periods of stay for the last seven years in a work-authorized capacity and indicate the beneficiary's immigration status and visa category (for example, H-1B, O-1) during the period of stay. If you need extra space to complete this section, use the space provided in Part 10. Additional Information. Period of Stay 1 3.a. From (mm/dd/yyyy) 3.b. To (mm/dd/yyyy) 4. Nonimmigrant Status During Period of Stay Beneficiary's Foreign Mailing Address 6.a. In Care Of Name (if any) 6.b. Street Number and Name or PO Box 6.c. Apt. Ste. Flr. 6.d. City or Town 6.e. Province 6.f. Postal Code Period of Stay 2 5.a. From (mm/dd/yyyy) 5.b. To (mm/dd/yyyy) 6. Nonimmigrant Status During Period of Stay 6.g. Country 7. Is this mailing address also where the beneficiary physically resides? Yes No If you answered "No" to Item Number 7., provide the beneficiary's physical address in Item Numbers 8.a. - 8.f. Part 3. Information About the Beneficiary Provide the following information about the beneficiary. 1. 2. 3. Alien Registration Number (A-Number) (if any) AUSCIS Online Account Number (if any) U.S. Social Security Number (if any) Form I-129S 06/02/16 N American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 8 Part 3. Information About the Beneficiary (continued) Beneficiary's Foreign Physical Address 8.a. Street Number and Name 8.b. Apt. Ste. Flr. Wages and Hours of Proposed Employment Provide the wages per year the beneficiary will receive and the number of hours the beneficiary will work per week for the proposed employment. Also describe any other compensation the beneficiary will receive, including dollar value (if applicable). 4. 5. 6. Beneficiary's Wages Per Year $ Beneficiary's Hours Per Week Other Compensation 8.c. City or Town 8.d. Province 8.e. Postal Code 8.f. Country Proposed Job Title and Duties Other Information About the Beneficiary 9. 10. 11. 12. 13. 14. Date of Birth (mm/dd/yyyy) Gender Male Female Provide the job title and duties the beneficiary will perform. Also indicate the percentage of time the beneficiary will spend performing the duties on a daily basis. If you need extra space to complete this section, use the space provided in Part 10. Additional Information. 7. 8. Job Title Duties Performed on a Daily Basis City or Town of Birth Province or State of Birth Country of Birth Country of Citizenship or Nationality Primary Worksite If you need extra space to complete this section, use the space provided in Part 10. Additional Information. 9. If you are seeking L-1B specialized knowledge professional status for the beneficiary, will the beneficiary work primarily offsite (at a worksite of a company or organization other than the petitioner or its affiliate, branch, subsidiary, or parent company)? Yes No If you answered "Yes" to Item Number 9., describe how and who will control and supervise the beneficiary's work and why the placement is not labor for hire in Item Numbers 10.a. - 11. 10.a. Supervisor's Name 10.b. Nature of Supervision and Control of the Beneficiary's Work Part 4. Information About Proposed United States Employment 1. Provide the receipt number for the Blanket L petition upon which this petition is based. 2. Are you filing Form I-129, Petition for a Nonimmigrant Worker, with this petition? Yes No Proposed Employment Address for the Beneficiary 3.a. Street Number and Name 3.b. Apt. Ste. Flr. 3.c. City or Town 3.d. State 3.e. ZIP Code Page 3 of 8 Form I-129S 06/02/16 N American LegalNet, Inc. www.FormsWorkFlow.com Part 4. Information About Proposed United States Employment (continued) 11. Describe the reasons why the placement of the beneficiary at this worksite is not an arrangement to provide labor for hire. Also include a description of how the beneficiary's duties at this worksite relate