Form ETA 9033A ETA 9033A Attestations by Employers Using Crewmembers for Longshor

A ttestation by Employers Using Alien U.S. Department of Labor

Crewmembers for Longshore Activities Employment and Training Administration

At Locations in the State of Alaska OMB Approval No. 1205-0352 Exp. XX/XX/XXXX

1. Full Legal Name of Company	5. Name of U.S. Agent
2. Headquarters Address (No., St., City, State, Zip Code, Country)	6. U.S. Business Address of Agent (No., St., City, State, Zip Code)
3. Telephone (Area Code and Number) 4. Name of Chief Executive Officer	7. Telephone of Agent (Area Code and Number) Fax (Area Code and Number)

8. EMPLOYER ATTESTATION (Use attachment if additional space is needed or multiple locations are covered.)

(a) It is anticipated that longshore activities will be performed at the following times and locations in the State of Alaska (check appropriate box(es) below for each activity of longshore work to be performed):

First Performance of Activity (month/day/year) Location (name of port, city, or other geographical reference point)

_____________________________________ ____________________________________________________

□ (i) Loading cargo □ (ii) Unloading cargo

□ (iii) Operation of cargo-related equipments □ (iv) Handling of mooring lines

□ (b) Before using alien crewmen to perform any longshore activity, a bona fide request will be made to the parties to whom notice has been provided under item 8(e)(ii) and (iii) below, for United States longshore workers who are qualified and available in sufficient numbers to perform the longshore activity at the particular time and location, except that:

(i) wherever two or more contract stevedoring companies have signed a joint collective bargaining agreement with a labor organization described in 8(e)(i) below, the request for longshore workers may be made to only one such contract stevedoring company, and

(ii) a request for longshore workers to an operator of a private dock may be made only for longshore work to be performed at that dock and only if the operator meets the requirements of section 32 of the Longshore and Harbor Workers’ Compensation Act.

□ (c) All United States longshore workers who are made available in response to the request for dispatch as attested at item 8(b) above and who are qualified, available in sufficient numbers, and needed to perform the longshore activity at the particular time and location, will be employed to perform such activity.

□ (d) The use of alien crewmembers in any employ to perform any longshore activity is not intended or designed to influence an election of a bargaining representative for workers in the State of Alaska.

□ (e) As of this date, notice of this attestation has been provided to (include copies of actual notices):

(i) Labor organizations which have been recognized as exclusive bargaining representatives of United States longshore workers and which make available or intend to make available longshore workers to the particular location(s) where the longshore work is to be performed;

(ii) Contract stevedoring companies which employ or intend to employ United States longshore workers at the particular location(s) where the longshore work is to be performed; and

(iii) Operators of private docks at which workers in my employ will perform any longshore activity.

____________________________________________________________________________________________________________________________

9. DECLARATION OF EMPLOYER: Pursuant to 28 U.S.C. 1746 , I declare under penalty of perjury that the information provided on this form and accompanying documentation is true and correct. In addition, I declare that I will comply with the Department of Labor regulations governing this program and, in particular, that I will make this attestation, supporting documentation, and other records, files and documents available to officials of the Department, upon such official’s request, during any investigation under this attestation or the immigration and Nationality Act.

____________________________________________ ___________________________

Signature of Chief Executive Officer Date

(or such Officer’s U.S Agent or Designee

________________________________________________________________________________________________________

FOR U.S GOVERNMENT AGENCY USE ONLY: By virtue of my signature below, I acknowledge that this program attestation is accepted for filing on ___________(date) and will be valid for the longshore activities at locations in the state of Alaska herein attested to from _____________(beginning date) through___________ (date twelve months from beginning date).

___________________________________________ ______________________________

Signature of Authorized DOL Official ETA Case No.

Subsequent DOL action: Suspended________________Invalidated_____________Withdrawn_______________

The Department of Labor is not the guarantor of the accuracy, truthfulness or adequacy of an attestation accepted for filing.

___________________________________________________________________________________________________________________________

Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Respondents’ obligations to reply to these reporting requirements are mandatory. (8 U.S.C. 1101 et seq.)  Public reporting burden for this collection of information is estimated to average 4 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 or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Office of Foreign Labor Certification, 200 Constitution Avenue, N.W., Room C4312, Washington, D.C. 20210 (Paperwork Reduction Project 1206-0352).    

Page 1 of 2 ETA 9033-A (Dec. 1994)

ATTESTATION BY EMPLOYERS USING ALIEN CREWMEMBERS

FOR LONGSHORE ACTIVIES AT LOCATIONS IN THE STATE OF ALASKA

IMPORTANT: READ CAREFULLY BEFORE COMPLETING FORM

Submit the completed original Form ETA 9033-A with accompanying documentation along with two copies of the form and accompanying documentation. Attestation must be received by the Department of Labor no later then 30 days prior to the first performance of the longshore activity (or anytime up to 24 hours before the first performance on the activity upon a showing that the employer could not have reasonably anticipated the need to file an attestation for that location at the time). Attestations which are filed less than 30 days prior to the first performance of the longshore activity must include supporting documentation to show that the employer could not have reasonably anticipated the need to file attestation for that location at that time.

To knowingly furnish any false information in the preparation of this form and any supporting documentation thereto, or to aid, abet or counsel another to do so is a felony, punishable by $10,000 fine or five years in the penitentiary, or both (18 U.S.C. 1001). Other penalties apply as well to fraud and misuse of this immigration document (18 U.S.C. 1546) and to perjury with respect to this form (18 U.S.C. 1546 and 1621).

Print legibly in ink or use a typewriter. Sign and date one form in original signature. Citations below to “regulations” are citations to 20 CFR Part 655, Subparts F and G.

Item 1. Name of Company. Enter full legal name of business, firm or organization, or if an individual, enter name used for legal purposes on documents. Item 2. Address of Company. Self Explanatory. Item 3. Telephone Number. Include area code or international calling code. Item 4. Name of Chief Executive Officer. Self explanatory. Item 5. Name of U.S .Agent . Self Explanatory. Item 6. Address of Agent. This address must be in the U.S. Item 7. Telephone Number. Include fax number, if available. Item 8. Employer Attestation. An employer must attest to the conditions listed in elements (b) through (e). The attestation will only be accepted for filing if the required documentation supporting elements 8(e) is attached to the Form ETA 9033-A. See §655.537 of the regulations for guidance on the documentation that must be attached to the Form ETA 9033-A to support element 8(e). The employer must check the appropriate box(es) 8(a) (i) through (iv) for each of the particular activities of longshore work to be performed. Item 8(a): Bona Fide Request for Dispatch of U.S. Longshore Workers. The employer must attest that, before using alien crewmen to perform longshore work, he will make a bona fide request for the U.S. longshore workers who are qualified and available in sufficient numbers to perform the activity at the particular times and locations specified. The request for dispatch must be directed to the parties to whom notice of filing is provided under attestation element 8(e) (ii) and (iii). Wherever two and more contract stevedoring companies have signed a joint collective bargaining agreement with a labor organization described in attestation element 8(e)(i), the employer may request longshore workers from only one of such contract stevedoring company. A request for longshore workers to an operator of a private dock may be made only for longshore work to be performed at that dock and only if the operator meets the requirements of section 32 of the Longshore and Harbor Workers’ Compensation Act (33 U.S.C. 932). See § 655.534 of the regulations for a detailed explanation of this attestation element.

Item 8(b): Employment of all Qualified U.S. Longshore Workers Made Available in Sufficient Numbers. The employer must attest that all U.S. longshore workers made available in response to the request for dispatch under the first attestation element, item 8(b), who are qualified and available in sufficient number and who are needed to perform the longshore activity at the particular times and locations specified will be employed to perform such activity. See § 655.535 of the regulations for a detailed explanation of this attestation element. Item 8(c): No Intention or Design to Influence Bargaining Representative Election. The employer must attest that the use of alien crewmembers to perform longshore activities is not intended or designed to influence an election for a bargaining representative for longshore workers in the State of Alaska. See § 655.536 of the regulations for detailed explanation of this attestation element. Item 8(d): Notice of Filing. The employer must attest that at the time of filing the attestation, notice of filing has been provided to labor organizations which have been recognized as exclusive bargaining representatives of U.S. longshore workers and which make available or intend to make available workers to the particular locations where the longshore work is to be performed. Notice must also be provided to contract stevedoring companies which employ or intend to employ U.S. longshore workers at those locations, and to operators of private docks at which the employer will use longshore workers. See § 655.537 of the regulations for a detailed explanation of this attestation elements. Item 9. Declaration of Employer. One copy of this form must bear the original signature of the chief executive officer (or the chief executive officer’s designee) unless filing by facsimile transmission. See §655.532(a) of the regulations if filing by facsimile transmission. By signing this form, the chief executive officer is attesting to the conditions listed in item 8(a) through (c) and to the accuracy of the information provided elsewhere on the form and in supporting documentation. False statements are subject to federal criminal penalties, as stated above.

If the attestation bears the necessary entries of information and documentation, the Department of Labor may accept the attestation for filing and shall document such acceptance on each of the three Form ETA 9033A’s submitted.  A copy of the attestation form indicating the Department’s acceptance, or notification of nonacceptance, will be returned to the employer.  A copy of this attestation, along with accompanying documentation, will be available for public inspection at the Office of Foreign Labor Certification, 200 Constitution Avenue, N.W., Room C4312, Washington, D.C. 20210.

                                                                                                                                                                                                                        

Page 2 of 2 ETA 9033-A (Dec. 1994)