Form I-129 - Petition For A Nonimmigrant Worker - Department Of Homeland Security Page 30
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36R-1 Classification
USCIS
Supplement to Form I-129
Form I-129
Department of Homeland Security
OMB No. 1615-0009
U.S. Citizenship and Immigration Services
Expires 10/31/2016
1.
Name of the Petitioner
2.
Name of the Beneficiary
Section 1. Complete This Section If You Are Filing For An R-1 Religious Worker
Employer Attestation
Provide the following information about the
petitioner:
1.a. Number of members of the petitioner's religious organization?
1.b. Number of employees working at the same location where the beneficiary will be employed?
1.c. Number of aliens holding special immigrant or nonimmigrant religious worker status currently
employed or employed within the past five years?
1.d. Number of special immigrant religious worker petition(s) (I-360) and nonimmigrant religious
worker petition(s) (I-129) filed by the petitioner within the past five years?
2.
Has the beneficiary or any of the beneficiary's dependent family members previously been admitted
Yes
No
to the United States for a period of stay in the R visa classification in the last five years?
If yes, complete the spaces below. List the beneficiary and any dependent family member’s prior periods of stay in the R visa
classification in the United States in the last five years. Please be sure to list only those periods in which the beneficiary and/or
family members were actually in the United States in an R classification.
NOTE: Submit photocopies of Forms I-94 (Arrival-Departure Record), I-797 (Notice of Action), and/or other USCIS
documents identifying these periods of stay in the R visa classification(s). If more space is needed, provide the information in
Part 9. of Form I-129.
Period of Stay (mm/dd/yyyy)
Alien or Dependent Family Member's Name
From
To
Form I-129 08/13/15 Y
R-1 Classification Supplement
Page 30 of 36
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