Form I-130 - Petition For Alien Relative Page 4

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Employer 2
Part 2. Information About You (Petitioner)
(continued)
46.
Name of Employer/Company
If you are a lawful permanent resident, complete Item
Numbers 40.a. - 41.
47.a.
Street Number
and Name
40.a. Class of Admission
47.b.
Apt.
Ste.
Flr.
40.b. Date of Admission (mm/dd/yyyy)
47.c.
City or Town
Place of Admission
47.d.
47.e.
State
ZIP Code
40.c. City or Town
47.f.
Province
47.g. Postal Code
40.d State
47.h.
Country
41.
Did you gain lawful permanent resident status through
marriage to a U.S. citizen or lawful permanent resident?
Yes
No
48.
Your Occupation
Employment History
49.a.
Date From (mm/dd/yyyy)
Provide your employment history for the last five years, whether
inside or outside the United States. Provide your current
49.b.
Date To (mm/dd/yyyy)
employment first. If you are currently unemployed, type or print
"Unemployed" in Item Number 42.
Part 3. Biographic Information
Employer 1
NOTE: Provide the biographic information about you, the
42.
Name of Employer/Company
petitioner.
1.
Ethnicity (Select only one box)
43.a.
Street Number
Hispanic or Latino
and Name
Not Hispanic or Latino
43.b.
Apt.
Ste.
Flr.
2.
Race (Select all applicable boxes)
43.c.
City or Town
White
43.d.
43.e.
State
ZIP Code
Asian
Black or African American
43.f.
Province
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
43.g. Postal Code
3.
Height
Feet
Inches
43.h.
Country
4.
Weight
Pounds
44.
Your Occupation
5.
Eye Color (Select only one box)
Black
Blue
Brown
45.a.
Date From (mm/dd/yyyy)
Gray
Green
Hazel
Maroon
Pink
Unknown/Other
45.b.
Date To (mm/dd/yyyy)
Form I-130 02/27/17 N
Page 4 of 12

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