Form ETA-9089 Application for Permanent Labor Certification

Application for Permanent Employment Certification

Form ETA Form 9089

U.S. Department of Labor

OMB Approval: 1205-0451

Expiration Date: 03/31/2008

OMB Approval: 1205-0451

Expiration Date:

P lease read and review the filing instructions before completing this form. A copy of the instructions can be found at http://www.plc.doleta.gov/ www.http://workforcesecurity.doleta.gov/foreign/.

Employing or continuing to employ an alien unauthorized to work in the United States is illegal and may subject the employer to criminal prosecution, civil money penalties, or both.

A. Refiling Instructions

• Yes

• No

1. Are you seeking to utilize the filing date from a previously submitted Application for Alien Employment Certification (ETA 750)?
1-A. If Yes, enter the previous filing date
1-B. Indicate the previous SWA or local office case number OR if not available, specify state where case was originally filed:

B. Schedule A or Sheepherder Information

• Yes

• No

1. Is this application in support of a Schedule A or Sheepherder Occupation?
If Yes, do NOT send this application to the Department of Labor. All applications in support of Schedule A or Sheepherder Occupations must be sent directly to the appropriate United States Citizenship and Immigration Services (CDepartment of Homeland Security officeIS).

C. Employer Information (Headquarters or Main Office)

1. Employer’s name
2. Address 1
Address 2
3. City State/Province Country Postal code
4. Phone number Extension
5. Number of employees in area of intended employment 6. Year commenced business
7. FEIN (Federal Employer Identification Nnumber) 8. NAICS code
9 Yes . Is the employer a closely held corporation, partnership, or sole proprietorship in which the alien has an ownership interest, or is there a familial relationship between the owners, stockholders, partners, corporate officers, incorporators, and the alien?	No

D. Employer Contact Information (This section must be filled out. This information must be different from the

agent or attorney information listed in Section E).

1. Contact’s last name First name Middle initial

2. Address 1

Address 2

3. City State/Province Country Postal code

4. Phone number Extension

5. E-mail address

E. Agent or Attorney Information (If applicable)

1. Agent or attorney’s last name First name Middle initial

2. Firm name

3. Firm EIN 4. Phone number Extension

5. Address 1

Address 2

6. City State/Province Country Postal code

7. E-mail address

F. Prevailing Wage Information (as provided by the State Workforce Agency)

1. Prevailing wage tracking number (if applicable) 2. SOC/O*NET(OES) code

3. Occupation Title 4. Skill Level

5

$

. Prevailing wage Per: (Choose only one)

• Hour

• Month

• Week

• Year

• Bi-Weekly

6

• OES

. Prevailing wage source (Choose only one)

• SCA

• DBA

• CBA

• Employer Conducted Survey

• Other

6-A. If Other is indicated in question 6, specify:

7. Determination date 8. Expiration date

G. Wage Offer Information

1. Offered wage

From: To: (Optional) Per: (Choose only one)

• Hour

• Month

• Week

• Year

• Bi-Weekly

$ $

H. Job Opportunity Information (Where work will be performed)

1. Primary worksite (where work is to be performed) address 1

Address 2

2. City State Postal code

3. Job title

4. Education: minimum level required:

• None

• High School

• Associate’s

• Bachelor’s

• Master’s

• Doctorate

• Other

4-A. If Other is indicated in question 4, specify the education required:

4-B. Major field of study

5

• No

• Yes

. Is training required in the job opportunity? 5-A. If Yes, number of months of training required:

H. Job Opportunity Information Continued

5-B. Indicate the field of training:
6. Is experience in the job offered required for the job? 6-A. If Yes, number of months experience required: No Yes
7 Yes No . Is there an alternate field of study that is acceptable?
7-A. If Yes, specify the major field of study:
8 Yes No . Is there an alternate combination of education and experience that is acceptable?
8-A. If Yes, specify the alternate level of education required: None High School Associate’s Bachelor’s Master’s Doctorate Other
8-B. If Other is indicated in question 8-A, indicate the alternate level of education required:
8-C. If applicable, indicate the number of years experience acceptable in question 8:
9 Yes No . Is a foreign educational equivalent acceptable?
10. Is experience in an alternate occupation acceptable? 10-A. If Yes, number of months experience in alternate occupation required: No Yes
10-B. Indentify the job title of the acceptable alternate occupation:
11. Job duties – If submitting by mail, add attachment if necessary. Job duties description must begin in this space.
1 Yes 2. Are the job opportunity’s requirements normal for the occupation? If the answer to this question is No, the employer must be prepared to provide documentation demonstrating that the job requirements are supported by business necessity.	No
1 Yes 3. Is knowledge of a foreign language required to perform the job duties? If the answer to this question is Yes, the employer must be prepared to provide documentation demonstrating that the language requirements are supported by business necessity.	No
14. Specific skills or other requirements – If submitting by mail, add attachment if necessary. Skills description must begin in this space.

H. Job Opportunity Information Continued

H. Job Opportunity Information Continued

14. Specific skills or other requirements – If submitting by mail, add attachment if necessary. Skills description must begin in this space.
1 Yes 5. Does this application involve a job opportunity that includes a combination of occupations?	No
1 Yes 6. Is the position identified in this application being offered to the alien identified in Section J?	No
1 Yes 7. Does the job require the alien to live on the employer’s premises?	No
1 Yes 8. Is the application for a live-in household domestic service worker?	No
1 Yes 8-A. If Yes, have the employer and the alien executed the required employment contract and has the employer provided a copy of the contract to the alien?	No NA
1 Yes 5. Does this application involve a job opportunity that includes a combination of occupations?	No
1 Yes 6. Is the position identified in this application being offered to the alien identified in Section J?	No
1 Yes 7. Does the job require the alien to live on the employer’s premises?	No
1 Yes 8. Is the application for a live-in household domestic service worker?	No
1 Yes 8-A. If Yes, have the employer and the alien executed the required employment contract and has the employer provided a copy of the contract to the alien?	No NA

I. Recruitment Information

a. Occupation Type – All must complete this section.

I Yes s this application for a professional occupation, other than a college or university teacher? Professional occupations are those for which a bachelor’s degree (or equivalent) is normally required.	No
2 Yes . Is this application for a college or university teacher? If Yes, complete questions 2-A and 2-B below.	No
2 Yes -A. Did you select the candidate using a competitive recruitment and selection process?	No
2-B. Did you use the basic recruitment process for professional occupations?	Yes No

b. Special Recruitment and Documentation Procedures for College and University Teachers –

Complete only if the answer to question I.a.2-A is Yes.

3. Date alien selected:

4. Name and date of national professional journal in which advertisement was placed:

5. Specify additional recruitment information in this space. Add an attachment if necessary.

I. Recruitment Information Continued

c. Professional/Non-Professional Information –

Complete this section unless your uanswer to question B.1 or

I.a.2-A is YES.

r answers to questions I.a.1 is NO and I.a.2.B is YES

6. Start date for the SWA job order 7. End date for the SWA job order

8

• No

• Yes

. Is there a Sunday edition of the newspaper in the area of intended employment?

9. Name of newspaper (of general circulation) in which the first advertisement was placed:

10. Date of first advertisement identified in question 9:

11. Name of newspaper or professional journal (if applicable) in which second advertisement was placed (if applicable):.

• Newspaper

• Journal

I. Recruitment Information Continued

12. Date of second Sunday newspaper advertisement (if newspaper) or date of publication of journal advertisement (if other than newspaper) identified

in question 11:

d. Professionald. Professional Recruitment I Information – Complete if the answer to question I.a.1 is YESYes or if the answer to I.a.2-B is YesYES.

Complete at least 3 of the items.

13. Dates advertised at job fair 14. Dates of on-campus recruiting

From: To: From: To:

15. Dates posted on employer web site 16. Dates advertised with trade or professional organization

From: To: From: To:

17. Dates listed with job search web site 18. Dates listed with private employment firm

From: To: From: To:

19. Dates advertised with employee referral program 20. Dates advertised with campus placement office

From: To: From: To:

21. Dates advertised with local or ethnic newspaper 22. Dates advertised with radio orand TV ads

From: To: From: To:

e. General Information – All must complete this section.

2 Yes 3. Has the employer received payment of any kind for the submission of this application?	No
23-A. If Yes, describe details of the payment including the amount, date and purpose of the payment specify:
H Yes as the bargaining representative for workers in the occupation in which the alien will be employed been provided with notice of this filing at least 30 days but not more than 180 days before the date the application is filed?	No NA
2 Yes 5. If there is no bargaining representative, has a notice of this filing been posted for 10 business days in a conspicuous location at the place of employment, ending at least 30 days before but not more than 180 days before the date the application is filed?	No NA
Yes Has the employer had a layoff in the area of intended employment in the occupation involved in this application or in a related occupation within the six months immediately preceding the filing of this application?	No
2 Yes 6-A. If Yes, were the laid off U.S. workers notified and considered for the job opportunity for which certification is sought?	No NA

J. Alien Information (This section must be filled out. This information must be different from the agent

or attorney information listed in Section E).

1. Alien’s last name First name Full middle name

2. Current address 1

Address 2

3. City State/Province Country Postal code

4. Phone number of current residence

5. Country of citizenship 6. Country of birth

7. Alien’s date of birth 8. Class of admission

9. Alien registration number (A#) 10. Alien admission number (I-94)

11. Education: highest level achieved relevant to the requested occupation:

• None

• High School

• Associate’s

• Bachelor’s

• Master’s

• Doctorate

• Other

J. Alien Information Continued

10. A lien Information Continued

3. City State/Province Country Postal code
4. Phone number of current residence
5. Country of citizenship 6. Country of birth
7. Alien’s date of birth 8. Class of admission
9. Alien registration number (A#) 10. Alien admission number (I-94)
11. Education: highest level achieved relevant to the requested occupation: None High School Doctorate Other Master’s Bachelor’s Associate’s
11-A. If Other indicated in question 11, specify
12. Specify major field(s) of study
13. Year relevant education completed
14. Institution where relevant education specified in question 11 was received
15. Address 1 of conferring institution
Address 2
16. City State/Province Country Postal code
1 Yes 7. Did the alien complete the training required for the requested job opportunity, as indicated in question H.5?	No NA
1 Yes 8. Does the alien have the experience as required for the requested job opportunity indicated in question H.6?	No NA
1 Yes 9. Does the alien possess the alternate combination of education and experience as indicated in question H.8?	No NA
2 Yes 0. Does the alien have the experience in an alternate occupation specified in question H.10?	No NA
D Yes id the alien gain any of the qualifying experience with the employer in a position substantially comparable to the job opportunity requested?	No NA
2 Yes 2. Did the employer pay for any of the alien’s education or training necessary to satisfy any of the employer’s job requirements for this position?	No
2 Yes 3. Is the alien currently employed by the petitioning employer?	No

K. Alien Work Experience

List all jobs the alien has held during the past 3 years. Also list any other experience that qualifies the alien for the job opportunity for which the employer is seeking certification.

a. Job 1

1. Employer name

2. Address 1

K . Alien Work Experience Continued

Address 2

3. City State/Province Country Postal code

4 . Type of business 5. Job title

6. Start date 7. End date 8. Number of hours worked per week

Job 1 continued on next page

K. Alien Work Experience Continued

K. Alien Work Experience Continued

9. Job details (duties performed, use of tools, machines, equipment, skills, qualifications, certifications, licenses, etc. Include the phone number of the employer and the name of the alien’s supervisor.)

b. Job 2

Address 2

3. City State/Province Country Postal code

4 . Type of business 5. Job title

6. Start date 7. End date 8. Number of hours worked per week

9. Job details (duties performed, use of tools, machines, equipment, skills, qualifications, certifications, licenses, etc. Include the phone number of the employer and the name of the alien’s supervisor.)

1. Employer name

2. Address 1

Address 2

3. City State/Province Country Postal code

4. Type of business 5. Job title

6. Start date 7. End date 8. Number of hours worked per week

9. Job details (duties performed, use of tools, machines, equipment, skills, qualifications, certifications, licenses, etc. Include the phone number of the employer and the name of the alien’s supervisor.)

b. Job 2

1. Employer name

2. 2. Address 1

4. Address 2

6. 3. City State/Province Country Postal code

8. 4. Type of business 5. Job title

10. 6. Start date 7. End date 8. Number of hours worked per week

12. 9. Job details (duties performed, use of tools, machines, equipment, skills, qualifications, certifications, licenses, etc. Include the phone number of the employer and the name of the alien’s supervisor.)etc.)

c. Job 3

1. Employer name

26. 2. Address 1

28. Address 2

K . Alien Work Experience Continued

3. City State/Province Country Postal code

4. Type of business 5. Job title

6. Start date 7. End date 8. Number of hours worked per week

9. Job details (duties performed, use of tools, machines, equipment, skills, qualifications, certifications, licenses, etc. Include the phone number of the employer and the name of the alien’s supervisor.)etc.)

1. Employer name

2. Address 1

Address 2

3. City State/Province Country Postal code

4. Type of business 5. Job title

6. Start date 7. End date 8. Number of hours worked per week

Job 3 continued on next page

K. Alien Work Experience Continued

9. Job details (duties performed, use of tools, machines, equipment, skills, qualifications, certifications, licenses, etc. Include the phone number of the employer and the name of the alien’s supervisor.)

L. Alien Declaration

I declare under penalty of perjury that Sections J and K are true and correct. I understand that to knowingly furnish false information in the preparation of this form and any supplement thereto or to aid, abet, or counsel another to do so is a federal offense punishable by a fine or imprisonment up to five years or both under 18 U.S.C. §§ 2 and 1001. Other penalties apply as well to fraud or misuse of ETA immigration documents and to perjury with respect to such documents under 18 U.S.C. §§ 1546 and 1621.(18 U.S.C. 2, 1001).

In addition, I further declare under penalty of perjury that I intend to accept the position offered in Section H of this application if I am granted a labor certificatiocertification nis approved and I am granted aor visa or an adjustment of status based on this application.

1. Alien’s last name First name Full middle name

2. Signature Date signed

Note – The signature and date signed do not have to be filled out when electronically submitting to the Department of Labor for processing, but must be complete when submitting by mail. If the application is submitted electronically, any resulting certification MUST be signed immediately upon receipt from DOL before it can be submitted to USCIS for final processing.

M. Declaration of Preparer

1. Was the application completed by the employer? If No, you must complete this section.

Yes No

I hereby certify that I have prepared this application at the direct request of the employer listed in Section C and that to the best of my knowledge the information contained herein is true and correct. I understand that to knowingly furnish false information in the preparation of this form and any supplement thereto or to aid, abet, or counsel another to do so is a federal offense punishable by a fine, imprisonment up to five years or both under (18 U.S.C. §§ 2 and 10012, 1001). Other penalties apply as well to fraud or misuse of ETA immigration documents and to perjury with respect to such documents under 18 U.S.C. §§ 1546 and 1621.

2. Preparer’s last name First name Middle initial

3. Title

4. E-mail address

5. Signature Date signed

Note – The signature and date signed do not have to be filled out when electronically submitting to the Department of Labor for processing, but must be complete when submitting by mail. If the application is submitted electronically, any resulting certification MUST be signed immediately upon receipt from DOL before it can be submitted to USCIS for final processing.

N . Employer Declaration

By virtue of my signature below, I HEREBY CERTIFY the following conditions of employment:

1. The offered wage equals or exceeds the prevailing wage and I the employer will pay at least the prevailing wage from the time Permanent residency is granted or from the time the alien is admitted to take up the certified employment.

2. The wage is not based on commissions, bonuses or other incentives, unless Ithe employer guarantees a wage paid on a weekly, bi-weekly, or monthly basis that equals or exceeds the prevailing wage.

3. I have enough funds available to pay the wage or salary offered the alien.

4. I will be able to place the alien on the payroll on or before the date of the alien’s proposed entrance into the United States.

5. The employer’s job opportunity does not involve unlawful discrimination, by race, creed, color, national origin, age, sex, religion, handicap, or citizenship.

6. The employer’s job opportunity is not:

   1. Vacant because the former occupant is on strike or is being locked out in the course of a labor dispute involving a work stoppage; or

   2. At issue in a labor dispute involving a work stoppage.

7. The job opportunity’s terms, conditions, and occupational environment are not contrary to Federal, Sstate or local law.

8. The job opportunity has been and is clearly open to any U.S. worker.

9. The U.S. workers who applied for the job opportunity were rejected for lawful job-related reasons.

10. The job opportunity is for full-time, permanent employment for an employer other than the alien.

11. The job opportunity is for full-time, permanent employment for an employer other than the alien.

I hereby designate the agent or attorney identified in section E (if any) to represent me for the purpose of labor certification and, by virtue of my signature in Block 3 below, I take full responsibility for the accuracy of any representations made by my agent or attorney.

I declare under penalty of perjury that I have not and will not offer this labor certification for sale, barter, or purchase.

I declare under penalty of perjury that I have read and reviewed this application and that to the best of my knowledge the information contained therein is true and accurate. I understand that to knowingly furnish false information in the preparation of this form and any supplement thereto or to aid, abet, or counsel another to do so is a federal offense punishable by a fine or imprisonment up to five years or both under 18 U.S.C. §§ 2 and 1001. Other penalties apply as well to fraud or misuse of ETA immigration documents and to perjury with respect to such documents under 18 U.S.C. §§ 1546 and 1621.(18 U.S.C. 2, 1001).

1. Last name First name Middle initial

2. Title

3. Signature Date signed

Note – The signature and date signed do not have to be filled out when electronically submitting to the Department of Labor for processing, but must be complete when submitting by mail. If the application is submitted electronically, any resulting certification MUST be signed immediately upon receipt from DOL before it can be submitted to USCIS for final processing.

Note – The signature and date signed do not have to be filled out when electronically submitting to the Department of Labor for processing, but must be complete when submitting. If submitted electronically, the application MUST be signed immediately upon receipt before it can be submitted to USCIS for final processing.

O. U.S. Government Agency Use Only

Pursuant to the provisions of Section 212 (a)(5)(A) of the Immigration and Nationality Act, as amended, I hereby certify that there are not sufficient U.S. workers available and the employment of the above will not adversely affect the wages and working conditions of workers in the U.S. similarly employed.

This Certification is valid from _____________________ to _________________________.

______________________________________________ ______________________________

Signature of Certifying Officer Date Signed

______________________________________________ ______________________________

Case Number Filing Date

P. OMB Information Paperwork Reduction Act Information Control Number 1205-0451015

Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number.

Respondent’s obligation to reply to these reporting requirements isare required to obtain the benefits of permanent employment certification. (Immigration and NationalityNA Act, Section 212(a)(5)). Public reporting burden for this collection of information is estimated to average 1¼ hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate to the Division of Foreign Labor Certification * U.S. Department of Labor * Room C4312 * 200 Constitution Ave., NW * Washington, DC * 20210.

Do NOT send the completed application to this address.

Q. Privacy Statement Information

In accordance with the Privacy Act of 1974, as amended (5 U.S.C. 552a), you are hereby notified that the information provided herein is protected under the Privacy Act. The Department of Labor (Department or DOL) maintains a System of Records titled Employer Application and Attestation File for Permanent and Temporary Alien Workers (DOL/ETA-7) that includes this record.

 

Under routine uses for this system of records, case files developed in processing labor certification applications, labor condition applications, or labor attestations, may be released as follows: in connection with appeals of denials before the DOL Office of Administrative Law Judges and Federal courts, records may be released to the employers that filed such applications, their representatives, to named alien beneficiaries or their representatives, and to the DOL Office of Administrative Law Judges and Federal courts; and in connection with administering and enforcing immigration laws and regulations, records may be released to such agencies as the DOL Office of Inspector General, Employment Standards Administration, the Department of Homeland Security’s U.S. Citizenship and Immigration Services and Bureau of Immigration and Customs Enforcement, and the Department of State.

 

Further relevant disclosures may be made in accordance with the Privacy Act and under the following circumstances: in connection with federal litigation; for law enforcement purposes; to authorized parent locator persons under Pub. L. 93-647; to an information source or public authority in connection with personnel, security clearance, procurement, or benefit-related matters; to a contractor or their employees, grantees or their employees, consultants, or volunteers who have been engaged to assist the agency in the performance of Federal activities; for Federal debt collection purposes; to the Office of Management and Budget in connection with its legislative review, coordination, and clearance activities; to a Member of Congress or their staff in response to an inquiry of the Congressional office made at the written request of the subject of the record; in connection with records management; and to the news media and the public when a matter under investigation becomes public knowledge, the Solicitor of Labor determines the disclosure is necessary to preserve confidence in the integrity of the Department, or the Solicitor of Labor determines that a legitimate public interest exists in the disclosure of information, unless the Solicitor of Labor determines that disclosure would constitute an unwarranted invasion of personal privacy.

Form ETA Form 9089 This Certification is valid from ________________to________________ Page 15 of 15Page 0 of 10