Form I-130a - Supplemental Information For Spouse Beneficiary Page 2
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6Part 1. Information About You (The Spouse
Part 2. Information About Your Employment
Beneficiary)
Provide your employment history for the last five years,
whether inside or outside the United States. Provide your
9.a. Date From (mm/dd/yyyy)
current employment first. If you are currently unemployed,
type or print "Unemployed" in Item Number 1. below. If you
9.b. Date To (mm/dd/yyyy)
need extra space to complete this section, use the space
provided in Part 7. Additional Information.
Information About Parent 1
Employment History
Full Name of Parent 1
10.a.
Family Name
Employer 1
(Maiden Name)
1.
Name of Employer/Company
10.b.
Given Name
(First Name)
10.c.
Middle Name
2.a.
Street Number
and Name
11.
Date of Birth (mm/dd/yyyy)
2.b.
Apt.
Ste.
Flr.
12.
Sex
Male
Female
2.c.
City or Town
13.
City/Town/Village of Birth
2.d.
2.e.
State
ZIP Code
2.f.
Province
14.
Country of Birth
2.g. Postal Code
15.
City/Town/Village of Residence
2.h.
Country
16.
Country of Residence
3.
Your Occupation
Information About Parent 2
4.a.
Date From (mm/dd/yyyy)
Full Name of Parent 2
4.b.
Date To (mm/dd/yyyy)
17.a.
Family Name
(Last Name)
Employer 2
17.b.
Given Name
(First Name)
5.
Name of Employer/Company
17.c.
Middle Name
6.a.
Street Number
18.
Date of Birth (mm/dd/yyyy)
and Name
19.
Sex
Male
Female
6.b.
Apt.
Ste.
Flr.
20.
City/Town/Village of Birth
6.c.
City or Town
6.d.
6.e.
State
ZIP Code
21.
Country of Birth
6.f.
Province
22.
City/Town/Village of Residence
6.g. Postal Code
6.h.
Country
23.
Country of Residence
Form I-130A 02/27/17 N
Page 2 of 6
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