Form I-130A 02/27/17 N Page 3 of 6
Part 2. Information About Your Employment
7. Your Occupation
Provide your last occupation outside the United States if not
shown above. If you never worked outside the United States,
provide this information in the space provided in Part 7.
1. Name of Employer/Company
Date From (mm/dd/yyyy)8.a.
Date To (mm/dd/yyyy)8.b.
Date From (mm/dd/yyyy)4.a.
Date To (mm/dd/yyyy)4.b.
Part 3. Information About Your Employment
Outside the United States
The interpreter named in Part 5. read to me every
question and instruction on this form and my answer
to every question in
a language in which I am fluent, and I understood
2. At my request, the preparer name in Part 6.,
prepared this form for me based only upon
information I provided or authorized.
Spouse Beneficiary's Daytime Telephone Number3.
Spouse Beneficiary's Contact Information
Spouse Beneficiary's Email Address (if any)5.
Spouse Beneficiary's Mobile Telephone Number (if any)4.
Spouse Beneficiary's Certification
Copies of any documents I have submitted are exact photocopies
of unaltered, original documents, and I understand that USCIS
may require that I submit original documents to USCIS at a later
date. Furthermore, I authorize the release of any information
from any of my records that USCIS may need to determine my
eligibility for the immigration benefit I seek.
I further authorize release of information contained in this form,
in supporting documents, and in my USCIS records to other
entities and persons where necessary for the administration and
enforcement of U.S. immigration laws.
City or Town2.c.
2.g. Postal Code
2.b. Apt. Ste. Flr.
I can read and understand English, and I have read
and understand every question and instruction on this
form and my answer to every question.
NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.
Part 4. Spouse Beneficiary's Statement, Contact
Information, Certification, and Signature
Spouse Beneficiary's Statement
NOTE: Read the Penalties section of the Form I-130 and
Form I-130A Instructions before completing this part.
I certify, under penalty of perjury, that I provided or authorized
all of the information in this form, I understand all of the
information contained in, and submitted with, my form, and that
all of this information is complete, true, and correct.
Spouse Beneficiary's Signature
Date of Signature (mm/dd/yyyy)6.b.
Spouse Beneficiary's Signature (sign in ink)6.a.
NOTE TO ALL SPOUSE BENEFICIARIES: If you do not
completely fill out this form or fail to submit required documents
listed in the Instructions, USCIS may deny the Form I-130 filed
on your behalf.
Don't forget to sign in ink!