Fillable Form I-129: Petition for a Nonimmigrant Worker (University of California, Davis)

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Form I-129: Petition for a Nonimmigrant Worker (University of California, Davis)

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Form I-129 01/31/19
Page 1 of 36
For
USCIS
Use
Only
Petition for a Nonimmigrant Worker
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form I-129
OMB No. 1615-0009
Expires 01/31/2022
Classification Approved
Consulate/POE/PFI Notified
Extension Granted
COS/Extension Granted
Partial Approval (explain)
Action BlockReceipt
Class:
No. of Workers:
Job Code:
Validity Dates:
From:
To:
At:
Legal Name of Individual Petitioner
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.
Family Name (Last Name) Given Name (First Name) Middle Name
1.
Contact Information4.
Part 1. Petitioner Information
START HERE - Type or print in black ink.
2. Company or Organization Name
3. Mailing Address of Individual, Company or Organization
City or Town State ZIP Code
In Care Of Name
Street Number and Name
Apt. Flr. NumberSte.
Daytime Telephone Number
U.S. Social Security Number (if any)
Email Address (if any)
Individual IRS Tax Number
Mobile Telephone Number
Federal Employer Identification Number (FEIN)
5. Other Information
Postal Code CountryProvince
Not Applicable
University of California, Davis
SISS - International Center
One Shields Ave
Davis
CA
95616
USA
5307520864
siss@ucdavis.edu
Form I-129 01/31/19
Page 2 of 36
Part 2. Information About This Petition (See instructions for fee information)
1. Requested Nonimmigrant Classification (Write classification symbol):
2. Basis for Classification (select only one box):
New employment.
New concurrent employment.
Change of employer.
Amended petition.
Change in previously approved employment.
Continuation of previously approved employment without change with the same employer.
3. Provide the most recent petition/application receipt number for the
beneficiary. If none exists, indicate "None."
Notify the office in Part 4. so each beneficiary can obtain a visa or be admitted. (NOTE: A petition is not required for
E-1, E-2, E-3, H-1B1 Chile/Singapore, or TN visa beneficiaries.)
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.
Extend the stay of each beneficiary because the beneficiary(ies) now hold(s) this status.
Amend the stay of each beneficiary because the beneficiary(ies) now hold(s) this status.
4. Requested Action (select only one box):
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.)
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
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
2. Provide Name of Beneficiary
Family Name (Last Name) Given Name (First Name) Middle Name
Middle Name Given Name (First Name)Family Name (Last Name)
Provide all other names the beneficiary has used.
Include nicknames, aliases, maiden name, and names from all previous marriages
.
3.
4. Other Information
Date of birth Gender
Male Female
U.S. Social Security Number (if any)
(mm/dd/yyyy)
a.
b.
c.
d.
e.
f.
a.
b.
c.
d.
e.
f.
TN
1
Not Applicable
Oberlies
Gayle
Form I-129 01/31/19
Page 3 of 36
Date Passport or Travel Document
Expires (mm/dd/yyyy)
Country of Citizenship or Nationality
6. Current Residential U.S. Address (if applicable) (do not list a P.O. Box)
Employment Authorization Document (EAD)
Number (if any)
Student and Exchange Visitor Information System (SEVIS)
Number (if any)
ZIP CodeStateCity or Town
Ste. NumberFlr.Apt.
Street Number and Name
Current Nonimmigrant Status Date Status Expires or D/S
(mm/dd/yyyy)
Passport or Travel Document Country
of Issuance
Date Passport or Travel Document
Issued (mm/dd/yyyy)
5. If the beneficiary is in the United States, complete the following:
Country of Birth
I-94 Arrival-Departure Record Number
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.) (continued)
Date of Last Arrival (mm/dd/yyyy) Passport or Travel Document Number
Part 4. Processing Information
1. If a beneficiary or beneficiaries named in Part 3. 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) c. U.S. State or Foreign Country
Consulate Port of EntryPre-flight inspection
d. Beneficiary's Foreign Address
City or Town
Street Number and Name Apt. Flr. NumberSte.
Alien Registration Number (A-Number)
A-
Province of Birth
2. Does each person in this petition have a valid passport?
State
CountryPostal Code
Yes
No. If no, go to Part 9. and type or print your
explanation.
Province
Form I-129 01/31/19
Page 4 of 36
Part 4. Processing Information (continued)
5. Are you filing any applications for dependents with this petition?
Yes. If yes, proceed to Part 9. and list the beneficiary's(ies) name(s).
Yes. If yes, how many?
Yes. If yes, answer the questions below. No. If no, proceed to Item Number 9.
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.
9. Have you ever previously filed a nonimmigrant petition for this beneficiary?
7. Have you ever filed an immigrant petition for any beneficiary in this petition?
6. Is any beneficiary in this petition in removal proceedings?
8. Did you indicate you were filing a new petition in Part 2.?
a. Has any beneficiary in this petition ever been given the classification you are now requesting within the last seven years?
b. Has any beneficiary in this petition ever been denied the classification you are now requesting within the last seven years?
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?
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.
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?
Part 5. Basic Information About the Proposed Employment and Employer
1. Job Title 2. LCA or ETA Case Number
No
No
No
No
No
No
No
No
No
Yes. If yes, how many?
Yes. If yes, how many?
Yes. If yes, proceed to Part 9. and type or print your explanation.
Yes. If yes, proceed to Part 9. and type or print your explanation.
Yes. If yes, proceed to Part 9. and type or print your explanation.
Yes. If yes, proceed to Part 9. and type or print your explanation.
Yes. If yes, proceed to Item Number 11.b.
Attach the Form I-129 supplement relevant to the classification of the worker(s) you are requesting.
3. Are you filing any other petitions with this one?
Yes. If yes, how many? No
Not Applicable
Form I-129 01/31/19
Page 5 of 36
Part 5. Basic Information About the Proposed Employment and Employer (continued)
4. Did you include an itinerary with the petition?
5. Will the beneficiary(ies) work for you off-site at another company or organization's location?
12. Type of Business 13. Year Established
14. Current Number of Employees in the United States 15. Gross Annual Income 16. Net Annual Income
10. Other Compensation (Explain)
11. Dates of intended employment
From: To:
7. Is this a full-time position?
6. Will the beneficiary(ies) work exclusively in the Commonwealth of the Northern Mariana Islands (CNMI)?
If the answer to Item Number 7. is no, how many hours per week for the position?8.
Part 6. Certification Regarding the Release of Controlled Technology or Technical Data to Foreign
Persons in the United States
(This section of the form is required only for H-1B, H-1B1 Chile/Singapore, L-1, and O-1A petitions. It is not required for any other
classifications. Please review the Form I-129 General Filing Instructions before completing this section.)
Select Item Number 1. or Item Number 2. as appropriate. DO NOT select both boxes.
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
With respect to the technology or technical data the petitioner will release or otherwise provide access to the beneficiary, the petitioner
certifies that it has reviewed the Export Administration Regulations (EAR) and the International Traffic in Arms Regulations (ITAR)
and has determined that:
1.
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.
(mm/dd/yyyy)(mm/dd/yyyy)
No
Yes
No
Yes No
Yes
No
Yes
Wages:9. $ per (Specify hour, week, month, or year)
3. Address where the beneficiary(ies) will work if different from address in Part 1.
Ste. NumberFlr.Apt.Street Number and Name
ZIP CodeStateCity or Town
Standard Benefits
Institution of Higher Education
1905
Not for Profit
Not for Profit
Form I-129 01/31/19
Page 6 of 36
Part 7. Declaration, Signature, and Contact Information of Petitioner or Authorized Signatory (Read
the information on penalties in the instructions before completing this section.)
Signature and Date2.
1.
Signature of Authorized Signatory Date of Signature
(mm/dd/yyyy)
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 8. Declaration, Signature, and Contact Information of Person Preparing Form, If Other Than
Petitioner
1.
Family Name (Last Name) Given Name (First Name)
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).)
2.
Name of Preparer
Family Name (Last Name)
Name and Title of Authorized Signatory
Given Name (First Name)
Signatory's Contact Information3.
Daytime Telephone Number Email Address (if any)
Title
Provide the following information concerning the preparer:
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.
Oberlies
Gayle
International Scholar Advisor
5307520864
siss@ucdavis.edu
Form I-129 01/31/19
Page 7 of 36
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.
Preparer's Declaration
5.
Signature of Preparer Date of Signature
(mm/dd/yyyy)
Signature and Date
Part 8. Declaration, Signature, and Contact Information of Person Preparing Form, If Other Than
Petitioner (continued)
3.
City or Town State ZIP Code
Street Number and Name
Apt. Flr. NumberSte.
Preparer's Mailing Address
Province CountryPostal Code
Preparer's Contact Information4.
Fax Number Daytime Telephone Number
Email Address (if any)
Not Applicable
Form I-129 01/31/19
Page 8 of 36
Part 9. Additional Information About Your Petition For Nonimmigrant Worker
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 9. 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.
A-Number
A-
2.
1.
Page Number Part Number Item Number
3.
Item NumberPart NumberPage Number
4.
Page Number Part Number Item Number
Form I-129 01/31/19
Page 11 of 36
Trade Agreement Supplement to Form I-129
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form I-129
OMB No. 1615-0009
Expires 01/31/2022
Trade Agreement Supplement
Name of the Petitioner
2. Name of the Beneficiary
1.
3. Employer is a (select only one box):
Foreign EmployerU.S. Employer
4. If Foreign Employer, Name the Foreign Country
Section 1. Information About Requested Extension or Change (See instructions attached to this form.)
Section 2. Petitioner's Declaration, Signature, and Contact Information (Read the information on
penalties in the instructions before completing this section.)
1. This is a request for Free Trade status based on (select only one box):
Free Trade, Canada (TN1)
Free Trade, Mexico (TN2)
Free Trade, Singapore (H-1B1)
Free Trade, Other
Free Trade, Chile (H-1B1) A sixth consecutive request for Free Trade, Chile or
Singapore (H-1B1)
Signature and Date
Name of Petitioner
2.
Signature of Petitioner Date of Signature
(mm/dd/yyyy)
I am filing this petition on behalf of an organization and I certify that I am authorized to do so by the organization.
3.
Mobile Telephone Number Email Address (if any)Daytime Telephone Number
Petitioner's Contact Information
1.
Family Name (Last Name) Given Name (First Name)
a. d.
e.
f.
b.
c.
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.
University of California, Davis
Oberlies
Gayle
5307520864
siss@ucdavis.edu
Form I-129 01/31/19
Page 12 of 36
3.
City or Town State ZIP Code
Street Number and Name
Apt. Flr. NumberSte.
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.
Preparer's Declaration
5.
Signature of Preparer
Date of Signature
(mm/dd/yyyy)
Preparer's Mailing Address
Trade Agreement Supplement
4.
Email Address (if any)
Daytime Telephone Number
Preparer's
Contact Information
Signature and Date
Province Country
Preparer's Business or Organization Name (if any)2.
Provide the following information concerning the preparer:
1.
Family Name (Last Name) Given Name (First Name)
Name of Preparer
Section 3. Declaration, Signature, and Contact Information of Person Preparing Form, If Other Than
Petitioner
(If applicable, provide the name of your accredited organization recognized by the Board of Immigration Appeals (BIA)).
Postal Code
Fax Number
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Form I-129: Petition for a Nonimmigrant Worker (University of California, Davis)

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Completed 9 September 2021

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