HR I-129 Application Form

HR I-129 APPLICATION FORM

Purpose: This form collects the information and authorizations required by the employer to prepare and file a petition for a nonimmigrant worker (I-129) on behalf of the prospective beneficiary and to perform employer-required verifications and background checks. Complete all sections fully and attach required supporting documents as indicated.

Personal Information (Beneficiary)

Date of Birth:    Country of Citizenship:    Passport Number:

Telephone:    Email:

Position and Petition Details

Department:    Reporting manager:

Requested start date:    Requested end date (if applicable):

Employer / Petitioner Information (if different from HR contact)

Employer contact name:    Contact phone:

Employment History (Most Recent Employer)

Job title:    Dates employed: From to

Employment History (Previous Employer)

Job title:    Dates employed: From to

Education

Graduation date:    Major / Field of study:

Professional References (Provide three)

Document Checklist (to attach to petition)

Copy of passport bio page    Resume / CV    Degree certificates / transcripts

Copies of prior approval notices (if any)    Recent pay stubs / employment verification    Other supporting documents (describe below)

Legal Disclosures and Authorizations

At-Will Employment Statement: Submission of this form does not create any contract of employment. If employed, the employment relationship will be at-will, which means either the employee or the employer may terminate the employment at any time with or without cause or notice, unless a signed written agreement states otherwise.

Equal Opportunity Employer: The employer provides equal employment opportunity to all applicants and employees without regard to protected characteristics as defined by applicable law.

Authorization to Verify and Background Check: By signing below, I authorize the employer and its authorized representatives to contact current and former employers, educational institutions, references, and other third parties to verify information provided herein and to conduct background checks as required for immigration petition support and employment eligibility verification. I further authorize disclosure of information obtained to counsel and designated company personnel for purposes of preparing and filing immigration-related petitions and responding to government requests.

Penalties for Misrepresentation: I understand that willful falsification, misrepresentation, or omission of material facts in connection with an immigration petition may subject me and/or the petitioner to civil or criminal penalties, including denial of benefits and possible prosecution under applicable law.

Applicant Certification and Signature

I certify under penalty of perjury that the information I have provided on this form and in all supporting documentation is true, complete, and correct to the best of my knowledge. I agree to promptly notify the employer of any material changes to the information provided. I authorize the release of records and information necessary to support the petition and to respond to inquiries from governmental authorities regarding my immigration status.

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