Part 5. Employment Creation Information
Number of full-time employees in the enterprise in U.S. (excluding you, your spouse, sons, and daughters)
When you made your initial investment?
Now
Difference
How many of these new jobs were
How many additional new jobs will be
created by your investment?
created by your additional investment?
What is your position, office, or title with the new commercial enterprise?
Briefly describe your duties, activities, and responsibilities.
What is the cost of your benefits?
$
What is your salary?
$
Part 6. Processing Information
Check One:
The person named in Part 1 is now in the United States, and an application to adjust status to permanent resident will be filed if this
petition is approved.
If the petition is approved and the person named in Part 1 wishes to apply for an immigrant visa abroad, complete the following for
that person:
Country of nationality:
Country of current residence or, if now in the United States, last permanent residence abroad:
If you provided a United States address in Part 1, print the person's foreign address:
If the person's native alphabet is other than Roman letters, write the foreign address in the native alphabet:
No
Are you in deportation or removal proceedings?
Yes (Explain on separate paper)
No
Have you ever worked in the United States without permission?
Yes (Explain on separate paper)
Part 7. Signature
Read the information on penalties in the instructions before completing this section.
I certify, under penalty of perjury under the laws of the United States of America, that this petition and the evidence submitted with it is
all true and correct. I authorize the release of any information from my records that U.S. Citizenship and Immigration Services needs to
determine eligibility for the benefit I am seeking.
Signature
Date
(
)
Mobile Phone Number
-
E-Mail Address
NOTE: If you do not completely fill out this form or fail to the submit the required documents listed in the instructions, you may not be
found eligible for the immigration benefit you are seeking and this petition may be denied.
Part 8.
Signature of Person Preparing Form, If Other Than Above (Sign below)
I declare that I prepared this application at the request of the above person, and it is based on all information of which I have knowledge.
Print Your
Signature
Date
Name
Daytime phone #
Firm Name
with area code
Address
Form I-526 (09/24/13) N Page 3