Form I-485 - Application To Register Permanent Residence Or Adjust Status Page 5
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A-Number
A-
Address of Employer or Company
Part 3. Additional Information About You
12.a.
Street Number
(continued)
and Name
Dates of Residence
12.b.
Apt.
Ste.
Flr.
8.a.
From (mm/dd/yyyy)
12.c.
City or Town
8.b.
To (mm/dd/yyyy)
12.d.
State
12.e.
ZIP Code
Provide your most recent address outside the United States
12.f.
Province
where you lived for more than one year (if not already listed
above).
12.g. Postal Code
9.a.
Street Number
and Name
12.h.
Country
9.b.
Apt.
Ste.
Flr.
13.
Your Occupation
9.c.
City or Town
9.d.
State
9.e.
ZIP Code
Dates of Employment
9.f.
Province
14.a.
From (mm/dd/yyyy)
9.g. Postal Code
14.b.
To (mm/dd/yyyy)
9.h.
Country
Employer 2
15.
Name of Employer or Company
Dates of Residence
10.a.
From (mm/dd/yyyy)
Address of Employer or Company
10.b.
To (mm/dd/yyyy)
16.a.
Street Number
and Name
Employment History
16.b.
Apt.
Ste.
Flr.
Provide your employment history for the last five years,
16.c.
City or Town
whether inside or outside the United States. Provide the most
recent employment first. If you need extra space to complete
16.d.
State
16.e.
ZIP Code
this section, use the space provided in Part 14. Additional
Information.
16.f.
Province
Employer 1 (current or most recent)
16.g. Postal Code
11.
Name of Employer or Company
16.h.
Country
17.
Your Occupation
Dates of Employment
18.a.
From (mm/dd/yyyy)
18.b.
To (mm/dd/yyyy)
Form I-485 06/26/17 N
Page 5 of 18
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