Form I-485 - Supplement J - Confirmation Of Bona Fide Job Offer Or Request For Job Portability Under Ina Section 204(J) Page 3

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Employer's U.S. Mailing Address
Part 4. Contact Information, Declaration, and
Signature of the Person Preparing This
2.a.
Street Number
and Name
Supplement, if Other Than the Applicant
(continued)
2.b.
Apt.
Ste.
Flr.
Preparer's Statement
2.c.
City or Town
I am not an attorney or accredited representative but
7.a.
2.d.
State
2.e.
ZIP Code
have prepared this supplement on behalf of the
applicant and with the applicant's consent.
Information About the Business Entity Employer
I am an attorney or accredited representative and my
7.b.
representation of the applicant in this case
If you, the employer, are a business entity, provide the
extends
does not extend beyond the
information requested in Item Numbers 3. - 10.
preparation of this supplement.
3.
Business or Organization Name
NOTE: If you are an attorney or accredited
representative, you may be obliged to submit a
completed Form G-28, Notice of Entry of
4.
Employer Identification Number
Appearance as Attorney or Accredited
►
Representative, with this supplement.
5.
Type of Business
Preparer's Certification
By my signature, I certify, under penalty of perjury, that I
6.
Date Established (mm/dd/yyyy)
prepared this supplement at the request of the applicant. The
applicant then reviewed this completed supplement and
7.
Current Number of U.S. Employees
informed me that he or she understands all of the information
contained in, and submitted with, his or her supplement,
8.
Gross Annual Income
$
including the Applicant's Certification, and that all of this
information is complete, true, and correct.
9.
Net Annual Income
$
►
Preparer's Signature
10.
NAICS Code
8.a. Preparer's Signature (sign in ink)
Information About the Individual Employer (if
applicable)
8.b. Date of Signature (mm/dd/yyyy)
Your Current Legal Name (do not provide a
nickname)
IMPORTANT: The employer confirming an
existing bona fide job offer or offering you a new,
11.a. Family Name
(Last Name)
permanent job must complete Parts 5., 6., and 7.
11.b.
Given Name
(First Name)
11.c.
Middle Name
Part 5. Information About the Employer
12.
Date of Birth (mm/dd/yyyy)
1.
Type of employer (Select only one box):
Business/Organization
13.
U.S. Social Security Number (if any)
►
Self/Individual
14.
Annual Income
$
15.
Occupation
Form I-485 Supplement J 06/26/17 N
Page 3 of 7

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