Form I-129 - Petition For A Nonimmigrant Worker - Department Of Homeland Security Page 20

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Section 2.
Complete this section if you are filing for an R-1 religious worker (continued)
If yes, complete the blanks below. List the alien and any dependent family member’s prior periods of stay in the R visa classification
in the United States for the last five years. Be sure to list only those periods in which the alien 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 on additional sheets
of paper.
Period of Stay (mm/dd/yyyy)
Alien or Dependent Family Member's Name
From:
To:
3. Provide a summary of the type of responsibilities of those employees who work at the same location where the beneficiary will be
employed. If additional space is needed, provide the information on additional paper.
Position
Summary of the Type of Responsibilities for That Position
Form I-129 Supplement Q/R (Rev. 06/12/09)Y Page 20

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