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pdfOMB Approval: 1205-0451
Expiration Date: 06/30/2011
Application for Permanent Employment Certification
ETA Form 9089
U.S. Department of Labor
Please read and review the filing instructions before completing this form. A copy of the instructions
can be found at http://www.foreignlaborcert.doleta.gov/pdf/9089inst.pdf
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
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
Yes
No
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
1. Is this application in support of a Schedule A or Sheepherder Occupation?
Yes
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 Department of Homeland Security office.
No
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
6. Year commenced business
7. FEIN (Federal Employer Identification Number)
8. NAICS code
9. 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?
Yes
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
4. Phone number
State/Province
Country
Postal code
Extension
5. E-mail address
ETA Form 9089
Page 1 of 10
OMB Approval: 1205-0451
Expiration Date: 06/30/2011
Application for Permanent Employment Certification
ETA Form 9089
U.S. Department of Labor
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)
$
Week
Hour
6. Prevailing wage source (Choose only one)
OES
CBA
Employer Conducted Survey
Bi-Weekly
Month
SCA
DBA
Year
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
Week
Bi-Weekly
Month
Year
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. Is training required in the job opportunity?
No
Yes
ETA Form 9089
5-A. If Yes, number of months of training required:
Page 2 of 10
OMB Approval: 1205-0451
Expiration Date: 06/30/2011
Application for Permanent Employment Certification
ETA Form 9089
U.S. Department of Labor
H. Job Opportunity Information Continued
5-B. Indicate the field of training:
6. Is experience in the job offered required for the job?
Yes
6-A. If Yes, number of months experience required:
No
7. Is there an alternate field of study that is acceptable?
Yes
No
Yes
No
7-A. If Yes, specify the major field of study:
8. 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. Is a foreign educational equivalent acceptable?
10. Is experience in an alternate occupation acceptable?
Yes
Yes
No
10-A. If Yes, number of months experience in alternate
occupation required:
No
10-B. Identify 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.
12. Are the job opportunity’s requirements normal for the occupation?
Yes
No
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.
13. Is knowledge of a foreign language required to perform the job duties?
Yes
No
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.
14. Specific skills or other requirements – If submitting by mail, add attachment if necessary. Skills description must
begin in this space.
ETA Form 9089
Page 3 of 10
OMB Approval: 1205-0451
Expiration Date: 06/30/2011
Application for Permanent Employment Certification
ETA Form 9089
U.S. Department of Labor
H. Job Opportunity Information Continued
15. Does this application involve a job opportunity that includes a combination of
occupations?
Yes
No
16. Is the position identified in this application being offered to the alien identified
in Section J?
Yes
No
Yes
No
18. Is the application for a live-in household domestic service worker?
Yes
No
18-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?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
17. Does the job require the alien to live on the employer’s premises?
NA
I. Recruitment Information
a. Occupation Type – All must complete this section.
1.
Is 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.
2. Is this application for a college or university teacher?
If Yes, complete questions 2-A and 2-B below.
2-A. Did you select the candidate using a competitive recruitment and
selection process?
2-B. Did you use the basic recruitment process for professional occupations?
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.
c. Professional/Non-Professional Information – Complete this section unless your answer to question B.1 or
I.a.2-A is YES.
6. Start date for the SWA job order
7. End date for the SWA job order
8. Is there a Sunday edition of the newspaper in the area of intended employment?
Yes
No
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:
ETA Form 9089
Newspaper
Journal
Page 4 of 10
OMB Approval: 1205-0451
Expiration Date: 06/30/2011
Application for Permanent Employment Certification
ETA Form 9089
U.S. Department of Labor
I. Recruitment Information Continued
12. Date of second newspaper advertisement or date of publication of journal identified in question 11:
d. Professional Recruitment Information – Complete if the answer to question I.a.1 is YES or if the answer to
I.a.2-B is YES. 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 or TV ads
From:
To:
From:
To:
e. General Information – All must complete this section.
23. Has the employer received payment of any kind for the submission of this
Yes No
application?
23-A. If Yes, describe details of the payment including the amount, date and purpose of the payment :
24. Has 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?
25. 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?
26. 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?
26-A. If Yes, were the laid off U.S. workers notified and considered for the job
opportunity for which certification is sought?
Yes
No
NA
Yes
No
NA
Yes
No
Yes
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
ETA Form 9089
High School
Associate’s
Bachelor’s
Master’s
Doctorate
Other
Page 5 of 10
OMB Approval: 1205-0451
Expiration Date: 06/30/2011
Application for Permanent Employment Certification
ETA Form 9089
U.S. Department of Labor
J. Alien Information Continued
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
17. Did the alien complete the training required for the requested job opportunity,
as indicated in question H.5?
Yes
No
NA
18. Does the alien have the experience as required for the requested job
opportunity indicated in question H.6?
Yes
No
NA
19. Does the alien possess the alternate combination of education and experience
as indicated in question H.8?
Yes
No
NA
20. Does the alien have the experience in an alternate occupation specified in
question H.10?
Yes
No
NA
21. Did the alien gain any of the qualifying experience with the employer in a
position substantially comparable to the job opportunity requested?
Yes
No
NA
22. 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?
Yes
No
Yes
No
23. Is the alien currently employed by the petitioning employer?
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
Address 2
3. City
State/Province
4. Type of business
6. Start date
ETA Form 9089
Country
Postal code
5. Job title
7. End date
8. Number of hours worked per week
Page 6 of 10
OMB Approval: 1205-0451
Expiration Date: 06/30/2011
Application for Permanent Employment Certification
ETA Form 9089
U.S. Department of Labor
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
1. Employer name
2. Address 1
Address 2
3. City
State/Province
4. Type of business
6. Start date
Country
Postal code
5. Job title
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.)
c. Job 3
1. Employer name
2. Address 1
Address 2
3. City
State/Province
4. Type of business
6. Start date
ETA Form 9089
Country
Postal code
5. Job title
7. End date
8. Number of hours worked per week
Page 7 of 10
OMB Approval: 1205-0451
Expiration Date: 06/30/2011
Application for Permanent Employment Certification
ETA Form 9089
U.S. Department of Labor
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.
In addition, I further declare under penalty of perjury that I intend to accept the position offered in Section H of this
application if a labor certification is approved and I am granted a visa or an adjustment of status based on this
application.
1. Alien’s last name
First name
2. Signature
Full middle name
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
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.
ETA Form 9089
Page 8 of 10
OMB Approval: 1205-0451
Expiration Date: 06/30/2011
Application for Permanent Employment Certification
ETA Form 9089
U.S. Department of Labor
N. Employer Declaration
By virtue of my signature below, I HEREBY CERTIFY the following conditions of employment:
1.
2.
The offered wage equals or exceeds the prevailing wage and I will pay at least the prevailing wage.
The wage is not based on commissions, bonuses or other incentives, unless I 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 job opportunity does not involve unlawful discrimination by race, creed, color, national origin, age, sex,
religion, handicap, or citizenship.
6. The job opportunity is not:
a. 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
b. 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, state 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.
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 read and reviewed this application and that to the best of my knowledge
the information contained herein 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.
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.
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.
______________________________________________
Signature of Certifying Officer
______________________________
Date Signed
______________________________________________
Case Number
______________________________
Filing Date
ETA Form 9089
Page 9 of 10
OMB Approval: 1205-0451
Expiration Date: 06/30/2011
Application for Permanent Employment Certification
P. OMB Information
ETA Form 9089
U.S. Department of Labor
Paperwork Reduction Act Information Control Number 1205-0451
Persons are not required to respond to this collection of information unless it displays a currently valid OMB
control number.
Respondent’s reply to these reporting requirements is required to obtain the benefits of permanent
employment certification (Immigration and Nationality 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, 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.
ETA Form 9089
Page 10 of 10
| File Type | application/pdf |
| File Title | Microsoft Word - 9089 revised 03-01-05 FINAL with OMB number and expiration… |
| Author | Choi.Yoon-Hee |
| File Modified | 2011-04-01 |
| File Created | 2005-03-28 |