ETA 9142 Appendix Application for Temporary Employment Certification

O MB Control Number: 1205-0466

Expiration Date: 11/30/2011

Application for Temporary Employment Certification

ETA Form 9142 – APPENDIX B.1

U.S. Department of Labor

For Use in Filing Applications Under the H-2B Non-Agricultural Program ONLY

Employer Additional Declaration

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

1. I am aware that the Department of Labor intends to publish a Final Rule revising the methodology by which it calculates the prevailing wage. Before the effective date of this Final Rule, I will be provided a new prevailing wage by the National Processing Center in accordance with this new prevailing wage methodology.

2. I agree to pay all H-2B workers and U.S. workers recruited in connection with this H-2B application a wage that equals or exceeds the highest of the new prevailing wage provided to me by the National Processing Center, the applicable Federal minimum wage, State minimum wage, or local minimum wage from the effective date of the Department’s Final Rule implementing a new wage methodology until the end of the approved labor certification.

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 felony punishable by a $250,000 fine or 5 years in the Federal penitentiary or both (18 U.S.C. 1001).

1. Last (family) name	2. First (given) name	3. Middle initial
4. Title
5. Signature			6. Date signed

December 2010

ETA Form 9142 – Appendix B.1 FOR DEPARTMENT OF LABOR USE ONLY Page B.0 of B.1

Case Number:___________________ Case Status: __________________ Period of Employment: ______________ to _______________