Form ETA-9089, Application for Permanent Employment Certification Instructions
This form contains 189 fields organized into 61 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Additional Conditions of Offered Wage | ||
| Additional Conditions | Text |
Provide any additional conditions related to the offered wage, up to 500 characters.
|
| Additional Worksites Inquiry | ||
| Yes | Checkbox |
Check this box if work will be performed in geographic areas other than the one identified in Section F.a.
|
| No | Checkbox |
Check this box if work will not be performed in geographic areas other than the one identified in Section F.a.
|
| Advertisement Placement Type | ||
| Newspaper of general circulation | Checkbox |
Check this box if the employer used a newspaper of general circulation to place the other advertisement for the job opportunity. Fill only if 'Professional Occupation' is selected (for 1a or 1b).
Depends on:
Professional Occupation
|
| Professional journal | Checkbox |
Check this box if the employer used a professional journal to place the other advertisement for the job opportunity. Fill only if 'Professional Occupation' is selected (for 1a or 1b).
Depends on:
Professional Occupation
|
| N/A | Checkbox |
Check this box if neither a newspaper of general circulation nor a professional journal was used to place the other advertisement for the job opportunity. Fill only if 'Professional Occupation' is selected (for 1a or 1b).
Depends on:
Professional Occupation
|
| Appendix B Attachment Status | ||
| Yes | Radiobutton |
Check this box if a completed Appendix B is attached to this application. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| No | Radiobutton |
Check this box if a completed Appendix B is not attached to this application. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| N/A | Radiobutton |
Check this box if Appendix B is not applicable to this application. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Attorney Bar Information | ||
| State Bar Number(s) | Text |
Please enter the state bar number(s) of the attorney. Fill only if 'Attorney', 'Agent' is marked 'Attorney' or 'Agent' (if acting as an attorney), any.
Depends on:
Attorney, Agent
|
| State of Highest Court | Text |
Please provide the state of the highest court where the attorney is in good standing. Fill only if 'Attorney', 'Agent' is marked 'Attorney' or 'Agent' (if acting as an attorney), any.
Depends on:
Attorney, Agent
|
| Name of Highest State Court | Text |
Please provide the full name of the highest state court where the attorney is in good standing. Fill only if 'Attorney', 'Agent' is marked 'Attorney' or 'Agent' (if acting as an attorney), any.
Depends on:
Attorney, Agent
|
| Month | Checkbox |
Check this box if the offered wage is paid per month.
|
| Year | Checkbox |
Check this box if the offered wage is paid per year.
|
| Attorney or Agent Address | ||
| Attorney or Agent Address Line 1 | Text |
Please provide the first line of the attorney or agent's mailing address. Fill only if 'Attorney', 'Agent' is marked 'Attorney' or 'Agent', any.
Depends on:
Attorney, Agent
|
| Attorney/Agent Also Represents Worker – Yes | Checkbox |
Check this box if the employer has contracted with an agent or attorney that also represents the foreign worker covered by this application.
|
| Appendix A Attached – No | Checkbox |
Check this box if a completed Appendix A identifying the foreign worker being sponsored for permanent employment by the employer is not attached.
|
| Attorney/Agent Also Represents Worker – No | Checkbox |
Check this box if the employer has not contracted with an agent or attorney that also represents the foreign worker covered by this application.
|
| Supervised Recruitment Indicator – Yes | Checkbox |
Check this box if a completed Form ETA-9141 is attached to this application.
|
| Supervised Recruitment Indicator – No | Checkbox |
Check this box if a completed Form ETA-9141 is not attached to this application.
|
| Supervised Recruitment Indicator – N/A | Checkbox |
Check this box if the attachment of a completed Form ETA-9141 is not applicable to this application.
|
| Enter From The Wage Offer Cents Amount Here | CheckBox | |
| Attorney or Agent Name | ||
| Attorney/Agent Last Name | Text |
Please provide the last name or family name of the attorney or agent. Fill only if 'Attorney', 'Agent' is marked 'Attorney' or 'Agent', any.
Depends on:
Attorney, Agent
|
| Attorney/Agent First Name | Text |
Please provide the first name or given name of the attorney or agent. Fill only if 'Attorney', 'Agent' is marked 'Attorney' or 'Agent', any.
Depends on:
Attorney, Agent
|
| Attorney/Agent Middle Name(s) | Text |
Please provide the middle name(s) of the attorney or agent. Fill only if 'Attorney', 'Agent' is marked 'Attorney' or 'Agent', any.
Depends on:
Attorney, Agent
|
| Attorney | Checkbox |
Check this box if an attorney is representing the employer in filing this application.
|
| Agent | Checkbox |
Check this box if an agent is representing the employer in filing this application.
|
| None | Checkbox |
Check this box if no attorney or agent is representing the employer in filing this application.
|
| Appendix A Attached – Yes | Checkbox |
Check this box if a completed Appendix A identifying the foreign worker being sponsored for permanent employment by the employer is attached.
|
| Business Identification Numbers | ||
| Federal Employer Identification Number | Text |
Please provide the employer's Federal Employer Identification Number (FEIN) as issued by the IRS.
|
| NAICS Code | Text |
Please provide the employer's North American Industry Classification System (NAICS) code.
|
| Business Name | ||
| Legal Business Name | Text |
Please provide the full legal name of the business or organization.
|
| Trade Name (DBA) | Text |
Please provide the trade name or 'Doing Business As' name, if different from the legal business name.
|
| 14 Enter Number of current employees on payroll in the area of intended employment | CheckBox | |
| 15 Enter Year Commenced Business (if household, year issued FEIN) | CheckBox | |
| Combination of Occupations | ||
| Yes | Checkbox |
Check this box if the job opportunity involves a combination of occupations.
|
| No | Checkbox |
Check this box if the job opportunity does not involve a combination of occupations.
|
| Contact's Address | ||
| Address Line 1 | Text |
Please provide the primary street address for the employer point of contact.
|
| Address Line 2 | Text |
Please provide any additional address details, such as apartment, suite, floor, or building number.
|
| City | Text |
Please enter the city for the employer point of contact's address.
|
| State | Text |
Please enter the state for the employer point of contact's address. Fill only if 'Country' is 'USA'.
Depends on:
Country
|
| Postal Code | Text |
Please enter the postal code for the employer point of contact's address.
|
| Country | Text |
Please enter the country for the employer point of contact's address.
|
| Province | Text |
Please enter the province for the employer point of contact's address, if applicable. Fill only if 'Country' is not 'USA'.
Depends on:
Country
|
| Contact's Job Title | ||
| Contact's Job Title | Text |
Enter the job title of the employer's point of contact.
|
| Contact's Name | ||
| Contact's Last Name | Text |
Please provide the last name of the contact person.
|
| Contact's First Name | Text |
Please provide the first name of the contact person.
|
| Contact's Middle Name | Text |
Please provide the middle name(s) of the contact person.
|
| Contact's Phone and Email | ||
| Contact's Telephone Number | Text |
Please provide the telephone number of the employer's point of contact.
|
| Contact's Telephone Extension | Text |
Please provide the telephone extension for the employer's point of contact, if applicable. Fill only if 'Contact's Telephone Number' has a value.
Depends on:
Contact's Telephone Number
|
| Contact's Business Email Address | Text |
Please provide the business email address of the employer's point of contact.
|
| Credentialing Service Usage | ||
| Yes | Radiobutton |
Check this box if the employer used a credentialing service to qualify the foreign worker's education and/or experience requirements.
|
| No | Radiobutton |
Check this box if the employer did not use a credentialing service to qualify the foreign worker's education and/or experience requirements.
|
| N/A | Radiobutton |
Check this box if the question about using a credentialing service to qualify the foreign worker's education and/or experience requirements is not applicable.
|
| Current Employment Status | ||
| Yes | Checkbox |
Check this box if the foreign worker is currently employed by the employer submitting this application.
|
| No | Checkbox |
Check this box if the foreign worker is not currently employed by the employer submitting this application.
|
| Eighth Recruitment Event | ||
| Campus placement office | Checkbox |
Check this box if a campus placement office was utilized as a recruitment event for the job opportunity. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| Campus Placement Office From Date | Date |
Enter the start date of the recruitment period through a campus placement office. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| Campus Placement Office To Date | Date |
Enter the end date of the recruitment period through a campus placement office. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| Employer Address | ||
| Address Line 1 | Text |
Please enter the primary street address of the employer.
|
| Address Line 2 | Text |
Please enter the secondary address details, such as apartment, suite, floor, or building number, if applicable.
|
| City | Text |
Please enter the city where the employer is located.
|
| State | Text |
Please enter the state where the employer is located.
|
| Postal Code | Text |
Please enter the postal code or ZIP code for the employer's address.
|
| Country | Text |
Please enter the country where the employer is located.
|
| Province | Text |
Please enter the province, if applicable, where the employer is located.
|
| Employer Labor Condition Statements | ||
| Yes | Radiobutton |
Check this box if you certify under penalty of perjury your knowledge of and compliance with the applicable Labor Condition Statements.
|
| No | Radiobutton |
Check this box if you do not certify under penalty of perjury your knowledge of and compliance with the applicable Labor Condition Statements.
|
| Employer Payment for Worker's Education or Training | ||
| Yes | Radiobutton |
Check this box if the employer paid for any of the foreign worker's education or training necessary to satisfy any of the employer's requirements for the job opportunity. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| No | Radiobutton |
Check this box if the employer did not pay for any of the foreign worker's education or training necessary to satisfy any of the employer's requirements for the job opportunity. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| N/A | Radiobutton |
Check this box if the question regarding employer payment for education or training is not applicable to this situation. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Employer Telephone Number | ||
| Telephone Number | Text |
Please provide the primary telephone number for the employer.
|
| Extension | Text |
Please provide the telephone extension for the employer, if applicable.
|
| Employer's Willingness to Accept Suitable Combination | ||
| Accept | Checkbox |
Check this box if the employer is willing to accept a suitable combination of education, experience, or training for the job opportunity. Fill only if 'Yes', 'Yes' is 'Yes' for all.
Depends on:
Yes, Yes
|
| Do Not Accept | Checkbox |
Check this box if the employer is NOT willing to accept a suitable combination of education, experience, or training for the job opportunity. Fill only if 'Yes', 'Yes' is 'Yes' for all.
Depends on:
Yes, Yes
|
| Employment Contract Copy Provided | ||
| Yes | Radiobutton |
Check this box if the employer provided a copy of the employment contract to the foreign worker. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| No | Radiobutton |
Check this box if the employer did not provide a copy of the employment contract to the foreign worker. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| N/A | Radiobutton |
Check this box if the question about providing an employment contract copy is not applicable. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Employment Contract Execution Status | ||
| Yes | Radiobutton |
Check this box if the employer and foreign worker have executed the required employment contract. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| No | Radiobutton |
Check this box if the employer and foreign worker have not executed the required employment contract. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| N/A | Radiobutton |
Check this box if this question is not applicable, such as when 'Yes' was not marked in Question G.2. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Familial Relationship Question | ||
| Yes | Radiobutton |
Check this box if there is a familial relationship between the foreign worker and the owners, stockholders, partners, corporate officers, and/or incorporators.
|
| No | Radiobutton |
Check this box if there is no familial relationship between the foreign worker and the owners, stockholders, partners, corporate officers, and/or incorporators.
|
| Fifth Recruitment Event | ||
| Trade or professional organization | Checkbox |
Check this box if the employer used a trade or professional organization as one of the required recruitment events for professional occupations. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| Trade or Professional Organization From Date | Date |
Provide the start date of the recruitment event conducted through a trade or professional organization. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| Trade or Professional Organization To Date | Date |
Provide the end date of the recruitment event conducted through a trade or professional organization. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| First Recruitment Event | ||
| Job fair | Checkbox |
Check this box if the employer used a job fair as one of the recruitment events. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| Job Fair Start Date | Date |
Provide the start date for the first job fair recruitment event. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| Job Fair End Date | Date |
Provide the end date for the first job fair recruitment event. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| Foreign Diploma/Degree Acceptance | ||
| Yes | Radiobutton |
Check this box if the employer will accept a foreign diploma or degree that is equivalent to the required U.S. diploma or degree.
|
| No | Radiobutton |
Check this box if the employer will not accept a foreign diploma or degree equivalent to the required U.S. diploma or degree.
|
| N/A | Radiobutton |
Check this box if the question about accepting a foreign diploma or degree is not applicable.
|
| Foreign Language Proficiency Requirement | ||
| Yes | Checkbox |
Check this box if proficiency in a foreign language is required or preferred to perform the job duties identified in Section F of the PWD identified in Question E.1.
|
| No | Checkbox |
Check this box if proficiency in a foreign language is not required or preferred to perform the job duties identified in Section F of the PWD identified in Question E.1.
|
| Foreign Worker's Live-in Experience | ||
| Yes | Radiobutton |
Check this box if the foreign worker possesses one year of paid experience as a live-in household domestic service worker. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| No | Radiobutton |
Check this box if the foreign worker does not possess one year of paid experience as a live-in household domestic service worker. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| N/A | Radiobutton |
Check this box if question G.2 is not marked 'Yes', making this question not applicable. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Fourth Recruitment Event | ||
| On-campus recruiting | Checkbox |
Check this box if on-campus recruiting was utilized as one of the recruitment events. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| On-Campus Recruiting Start Date | Date |
Provide the start date for the on-campus recruiting event. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| On-Campus Recruiting End Date | Date |
Provide the end date for the on-campus recruiting event. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| Full-Time Employment Status | ||
| Yes | Checkbox |
Check this box if the position is a permanent position offering full-time employment of generally 35 hours or more.
|
| No | Checkbox |
Check this box if the position is not a permanent position or does not offer full-time employment of generally 35 hours or more.
|
| Geographic Area Identification | ||
| Other Definable Geographic Area | Text |
Provide a detailed description of the geographic area(s) where work will be performed, which may include a listing of cities, townships/states, counties/states, or states located within a geographic region. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Journal Advertisement Details | ||
| Journal Name | Text |
Please enter the name of the newspaper or professional journal where the advertisement was placed. Fill only if 'Professional Occupation' is selected (for 1a or 1b).
Depends on:
Professional Occupation
|
| Advertisement Date | Date |
Please enter the date the advertisement was placed. Fill only if 'Professional Occupation' is selected (for 1a or 1b).
Depends on:
Professional Occupation
|
| Law Firm/Business Information | ||
| Law Firm/Business Email Address | Text |
Provide the email address for the law firm or business. Fill only if 'Attorney', 'Agent' is marked 'Attorney' or 'Agent', any.
Depends on:
Attorney, Agent
|
| Law Firm/Business Name | Text |
Provide the full legal name of the law firm or business. Fill only if 'Attorney', 'Agent' is marked 'Attorney' or 'Agent', any.
Depends on:
Attorney, Agent
|
| Law Firm/Business FEIN | Text |
Provide the Federal Employer Identification Number (FEIN) for the law firm or business. Fill only if 'Attorney', 'Agent' is marked 'Attorney' or 'Agent', any.
Depends on:
Attorney, Agent
|
| Attorney | Checkbox |
Check this box if an attorney is representing the employer in the filing of this application.
|
| Agent | Checkbox |
Check this box if an agent is representing the employer in the filing of this application.
|
| None | Checkbox |
Check this box if no attorney or agent is representing the employer in the filing of this application.
|
| Week | Checkbox |
Check this box if the offered wage is paid per week.
|
| Bi-Weekly | Checkbox |
Check this box if the offered wage is paid every two weeks.
|
| Law Firm/Business FEIN | Text |
Please provide the Federal Employer Identification Number (FEIN) for the law firm or business. Fill only if 'Preparer' is a person other than the one identified in Section B (employer point of contact) or Section C (attorney or agent).
Depends on:
None, None
|
| Law Firm/Business Name | Text |
Please provide the full legal name of the law firm or business. Fill only if 'Preparer' is a person other than the one identified in Section B (employer point of contact) or Section C (attorney or agent).
Depends on:
None, None
|
| Law Firm/Business Email Address | Text |
Please provide the email address for the law firm or business. Fill only if 'Preparer' is a person other than the one identified in Section B (employer point of contact) or Section C (attorney or agent).
Depends on:
None, None
|
| Live-in Household Domestic Service Worker Certification | ||
| Yes | Checkbox |
Check this box if the employer is seeking permanent labor certification for a live-in household domestic service worker. Fill only if 'Type of worksite location that best describes where work will be performed' is 'Employer's private household (includes live-in and domestic household worker)'
Depends on:
Employer's private household (includes live-in and domestic household worker)
|
| No | Checkbox |
Check this box if the employer is not seeking permanent labor certification for a live-in household domestic service worker. Fill only if 'Type of worksite location that best describes where work will be performed' is 'Employer's private household (includes live-in and domestic household worker)'
Depends on:
Employer's private household (includes live-in and domestic household worker)
|
| MSA/OES Information | ||
| MSA/OES Area Code | Text |
Please enter the Metropolitan Statistical Area (MSA) or Occupational Employment Statistics (OES) area code for the worksite.
|
| MSA Name/OES Area Title | Text |
Please enter the name or title of the Metropolitan Statistical Area (MSA) or Occupational Employment Statistics (OES) area for the worksite.
|
| Newspaper Advertisement Details | ||
| Newspaper Name | Text |
Provide the name of the newspaper of general circulation in which an advertisement was placed. Fill only if 'Professional Occupation' is selected (for 1a or 1b).
Depends on:
Professional Occupation
|
| Advertisement Date | Date |
Provide the date the advertisement was placed in the newspaper. Fill only if 'Professional Occupation' is selected (for 1a or 1b).
Depends on:
Professional Occupation
|
| Ninth Recruitment Event | ||
| Local or ethnic newspaper | Checkbox |
Check this box if a local or ethnic newspaper was used as a recruitment event for the professional occupation. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| Ninth Recruitment Event Start Date | Date |
Enter the start date for the recruitment event conducted via local or ethnic newspaper. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| Ninth Recruitment Event End Date | Date |
Enter the end date for the recruitment event conducted via local or ethnic newspaper. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| Notice of Posting | ||
| Bargaining Representative | Checkbox |
Check this box if notice of this filing has been provided to the bargaining representative for workers in the occupation in which the foreign worker will be employed at least 30 days before, but not more than 180 days before, the date the application was filed.
|
| No Bargaining Representative - Physical Notice | Checkbox |
Check this box if notice of this filing has been physically posted to employees for consecutive business days in a conspicuous location at the places of employment at least 30 days before, but not more than 180 days before, the date this application was filed.
|
| No Bargaining Representative - Electronic Notice | Checkbox |
Check this box if notice of this filing has been disseminated electronically at least one (1) time, which is the employer's normal practice of informing current employees of job vacancies at least 30 days before, but not more than 180 days before, the date this application was filed.
|
| No Bargaining Representative - In-House Media | Checkbox |
Check this box if notice of this filing has been disseminated using all in-house media, which is the employer's normal practice of informing current employees of job vacancies at least 30 days before, but not more than 180 days before, the date this application was filed.
|
| No Bargaining Representative - Private Household | Checkbox |
Check this box if notice of this filing has been posted physically and/or disseminated electronically, in accordance with the employer's normal practice of informing current employees in the private household at least 30 days before, but not more than 180 days before, the date this application was filed. Fill only if 'Type of worksite location that best describes where work will be performed' is 'Employer's private household (includes live-in and domestic household worker)'
Depends on:
Employer's private household (includes live-in and domestic household worker)
|
| The employer DID NOT post the notice of filing | Checkbox |
Check this box if the employer did not post the notice of filing.
|
| Occupation Type | ||
| Professional Occupation | Checkbox |
Check this box if the application is for a professional occupation (not including college or university teachers selected using the competitive recruitment process) and recruiting was conducted under 20 CFR 656.17(e)(1).
|
| Schedule A or Sheepherder Occupation | Checkbox |
Check this box if the application is for a Schedule A or sheepherder occupation, and other options (1a, 1b, 1c) do not apply.
|
| Professional Athlete | Checkbox |
Check this box if the application is for a professional athlete, and other options (1a, 1b, 1c, 1d) do not apply.
|
| Non-Professional Occupation | Text |
Enter 'X' if this application is for a non-professional occupation where recruitment was conducted in accordance with 20 CFR 656.17(e)(2).
|
| College/University Teacher Occupation | Text |
Enter 'X' if this application is for a college or university teacher selected via a competitive recruitment process as per 20 CFR 656.18.
|
| Offered Wage | ||
| Offered Wage From | Number |
Provide the starting amount of the offered wage.
|
| OMB Approval: 1205-0451 | ||
| Radio and/or TV advertisement | Checkbox |
Check this box if the notice of posting was provided through a radio or TV advertisement.
|
| Advertisement From Date | Date |
Enter the start date for the radio and/or TV advertisement. Fill only if 'Radio and/or TV advertisement' is 'Yes'.
Depends on:
Radio and/or TV advertisement
|
| Advertisement To Date | Date |
Enter the end date for the radio and/or TV advertisement. Fill only if 'Radio and/or TV advertisement' is 'Yes'.
Depends on:
Radio and/or TV advertisement
|
| On-Premises Living Requirement | ||
| Yes | Checkbox |
Check this box if the job opportunity requires the worker to live on the employer's premises. Fill only if 'Type of worksite location that best describes where work will be performed' is 'Employer's private household (includes live-in and domestic household worker)'
Depends on:
Employer's private household (includes live-in and domestic household worker)
|
| No | Checkbox |
Check this box if the job opportunity does not require the worker to live on the employer's premises. Fill only if 'Type of worksite location that best describes where work will be performed' is 'Employer's private household (includes live-in and domestic household worker)'
Depends on:
Employer's private household (includes live-in and domestic household worker)
|
| Ownership Interest Question | ||
| Yes | Radiobutton |
The user should check this box if the employer is a closely held corporation, partnership, or sole proprietorship in which the foreign worker has an ownership interest.
|
| No | Radiobutton |
The user should check this box if the employer is not a closely held corporation, partnership, or sole proprietorship in which the foreign worker has an ownership interest.
|
| Payment Received for Application | ||
| Yes | Checkbox |
Check this box if the employer has received any kind of payment for the submission of this application.
|
| No | Checkbox |
Check this box if the employer has not received any kind of payment for the submission of this application.
|
| Preparer's Name | ||
| Preparer's Last Name | Text |
Enter the last (family) name of the preparer of this application. Fill only if 'Preparer' is a person other than the one identified in Section B (employer point of contact) or Section C (attorney or agent).
Depends on:
None, None
|
| Preparer's First Name | Text |
Enter the first (given) name of the preparer of this application. Fill only if 'Preparer' is a person other than the one identified in Section B (employer point of contact) or Section C (attorney or agent).
Depends on:
None, None
|
| Preparer's Middle Name(s) | Text |
Enter the middle name(s) of the preparer of this application. Fill only if 'Preparer' is a person other than the one identified in Section B (employer point of contact) or Section C (attorney or agent).
Depends on:
None, None
|
| Prevailing Wage Determination Case Number | ||
| PWD Case Number | Text |
Provide the valid Prevailing Wage Determination (PWD) case number issued by the Department of Labor for this application.
|
| Qualification via Alternative Requirements | ||
| Yes | Radiobutton |
Check this box if the foreign worker only qualifies for the job opportunity by virtue of the employer's alternative requirements. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| No | Radiobutton |
Check this box if the foreign worker does not only qualify for the job opportunity by virtue of the employer's alternative requirements. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| N/A | Radiobutton |
Check this box if the foreign worker is not currently working for the employer submitting this application (G.4 is 'No'). Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Qualifying Experience Gained with Employer | ||
| Yes | Radiobutton |
Check this box if the foreign worker gained any of the qualifying experience with the employer in a position substantially comparable to the job opportunity identified in Section F of the PWD identified in Question E.1. Fill only if the 'Is the employer relying solely on the experience the foreign worker gained while working for the employer, including as a contract employee to qualify him/her for the job opportunity covered by this application?' is 'Yes'. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| No | Radiobutton |
Check this box if the foreign worker did not gain any of the qualifying experience with the employer in a position substantially comparable to the job opportunity identified in Section F of the PWD identified in Question E.1. Fill only if the 'Is the employer relying solely on the experience the foreign worker gained while working for the employer, including as a contract employee to qualify him/her for the job opportunity covered by this application?' is 'Yes'. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| N/A | Radiobutton |
Check this box if the question about substantially comparable experience does not apply. Fill only if the 'Is the employer relying solely on the experience the foreign worker gained while working for the employer, including as a contract employee to qualify him/her for the job opportunity covered by this application?' is 'Yes'. Fill only if 'Yes' is 'Yes'.
Depends on:
Yes
|
| Recent Layoff Status | ||
| Yes | Checkbox |
Check this box if the employer has had a layoff in the occupation involved in this application or in a related occupation within the 6 months immediately preceding the filing of this application in the area of intended employment.
|
| No | Checkbox |
Check this box if the employer has NOT had a layoff in the occupation involved in this application or in a related occupation within the 6 months immediately preceding the filing of this application in the area of intended employment.
|
| Reliance on Experience Gained with Employer | ||
| Yes | Checkbox |
Check this box if the employer is relying solely on experience the foreign worker gained while working for the employer to qualify them for the job opportunity.
|
| No | Checkbox |
Check this box if the employer is not relying solely on experience the foreign worker gained while working for the employer to qualify them for the job opportunity.
|
| Second Recruitment Event | ||
| Employer website | Checkbox |
Check this box if the employer used its own website as a recruitment event to fulfill the additional recruitment requirements. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| Employer Website Recruitment From Date | Date |
Enter the start date of the recruitment period on the employer's website. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| Employer Website Recruitment To Date | Date |
Enter the end date of the recruitment period on the employer's website. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| Seventh Recruitment Event | ||
| Employee referral program | Checkbox |
Check this box if an employee referral program was used as one of the required recruitment events. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| Employee Referral Program From Date | Date |
Enter the start date of the employee referral program event. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| Employee Referral Program To Date | Date |
Enter the end date of the employee referral program event. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| Sixth Recruitment Event | ||
| Private employment firm | Checkbox |
Check this box if the employer used a private employment firm as one of the required recruitment events. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| Private Employment Firm Recruitment Start Date | Date |
Please enter the start date of the recruitment event conducted through a private employment firm. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| Private Employment Firm Recruitment End Date | Date |
Please enter the end date of the recruitment event conducted through a private employment firm. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| Supervised Recruitment Status | ||
| Supervised Recruitment Requirement: Yes | Checkbox |
Check this box if the employer is required, by notice from a Certifying Officer, to currently undergo supervised recruitment in accordance with 20 CFR 656.21.
|
| No | Checkbox |
Check this box if the employer is not required to currently undergo supervised recruitment by notice from a Certifying Officer.
|
| SVP Level Exceedance | ||
| Yes | Radiobutton |
Check this box if the job requirements identified in Section F of the PWD identified in Question E.1 exceed the Specific Vocational Preparation (SVP) level assigned to the occupation as shown in the O*NET Job Zones.
|
| No | Radiobutton |
Check this box if the job requirements identified in Section F of the PWD identified in Question E.1 do not exceed the Specific Vocational Preparation (SVP) level assigned to the occupation as shown in the O*NET Job Zones.
|
| N/A | Radiobutton |
Check this box if the question regarding whether job requirements exceed the SVP level is not applicable.
|
| SWA Job Order Dates | ||
| SWA Job Order Start Date | Date |
Enter the start date of the SWA job order. Fill only if 'Professional Occupation' is selected (for 1a or 1b).
Depends on:
Professional Occupation
|
| SWA Job Order End Date | Date |
Enter the end date of the SWA job order. Fill only if 'Professional Occupation' is selected (for 1a or 1b).
Depends on:
Professional Occupation
|
| Third Recruitment Event | ||
| Job search website | Checkbox |
Check this box if the employer used a job search website as one of the required recruitment events. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| Job Search Website Recruitment Start Date | Date |
Provide the start date for the recruitment activity conducted through a job search website. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| Job Search Website Recruitment End Date | Date |
Provide the end date for the recruitment activity conducted through a job search website. Fill only if 'Professional Occupation' is selected (for 1a).
Depends on:
Professional Occupation
|
| Worksite Address | ||
| Worksite Street Address | Text |
Provide the street number and name of the worksite address.
|
| Worksite Address (Apt/Suite/Floor) | Text |
Provide the apartment, suite, floor, or building number of the worksite address, if applicable.
|
| City | Text |
Provide the city where the worksite is located.
|
| County | Text |
Provide the county where the worksite is located.
|
| State/District/Territory | Text |
Provide the state, district, or territory where the worksite is located.
|
| Postal Code | Text |
Provide the postal code of the worksite location.
|
| Worksite Location Type | ||
| Business premises | Checkbox |
Check this box if the work will be performed at the employer's business premises.
|
| Employer's private household (includes live-in and domestic household worker) | Checkbox |
Check this box if the work will be performed at the employer's private household, which includes roles for live-in and domestic household workers.
|
| Employee's private residence (when work is performed directly out of the residence) | Checkbox |
Check this box if the work will be performed at the employee's private residence, provided the work is directly conducted from that residence.
|
| No one specific worksite address or physical location | Checkbox |
Check this box if there is no single, specific worksite address or physical location where the work will be performed.
|