ETA Form 9142 Application for Temporary Employment Certification, Fina

O MB Approval: 1205-0466

Expiration Date: 02/29/2012

Application for Temporary Employment Certification

ETA Form 9142

U.S. Department of Labor

Please read and review the filing instructions carefully before completing the ETA Form 9142. A copy of the instructions can be found at http://www.foreignlaborcert.doleta.gov/. In accordance with Federal Regulations, incomplete or obviously inaccurate applications will not be certified by the Department of Labor. If submitting this form non-electronically, ALL required fields/items containing an asterisk ( * ) must be completed as well as any fields/items where a response is conditional as indicated by the section ( § ) symbol.

A. Employment-Based Nonimmigrant Visa Information

1. Indicate the type of visa classification supported by this application (Write classification symbol): *

B. Temporary Need Information

1. Job Title *
2. SOC (ONET/OES) code *	3. SOC (ONET/OES) occupation title *
4. Is this a full-time position? *  Yes  No	Period of Intended Employment
	5. Begin Date * (mm/dd/yyyy)		6. End Date * (mm/dd/yyyy)
7. Total workers being requested for temporary labor certification in the job opportunity for the visa classification *
7a. Total workers employed in the job opportunity from the prior year a. Total workers* c. Total workers in the visa classification * (recruited from outside the U.S. and employed) b. Total U.S. workers* d. Total workers in the visa classification * (recruited from inside the U.S. and employed)
8. Nature of Temporary Need: (Choose only one of the standards) *  Seasonal  Peakload  One-Time Occurrence  Intermittent or Other Temporary Need
8a. For H-2B Applications ONLY, please enter the H-2B Registration Number (from an approved ETA Form 9155), if applicable. *
9. Statement of Temporary Need *

C. Employer Information

Important Note: Enter the full name of the individual employer, joint employer, job contractor, partnership, corporation and all other required information in this section. For joint employer or master applications filed on behalf of more than one employer, identify the main or primary employer in the section below and then submit a separate attachment that identifies each additional employer, by name, mailing address, and total worker positions needed, under the application.

1. Legal business name *
2. Trade name/Doing Business As (DBA), if applicable
3. Address 1 *
4. Address 2
5. City *	6. State *	7. Postal code *
8. Country *	9. Province
10. Telephone number *	11. Extension
12. Federal Employer Identification Number (FEIN from IRS) *	13. NAICS code (must be at least 4-digits) *
14. Type of employer application (choose only one box below) *  Individual Employer  Association – Sole Employer (H-2A only)  H-2A Labor Contractor or  Association – Joint Employer (H-2A only) H-2B Job Contractor  Association – Filing as Agent (H-2A only)  Joint Employer (H-2B only)

D. Employer Point of Contact Information

Important Note: The information contained in this Section must be that of an employee of the employer who is authorized to act on behalf of the employer in labor certification matters. The information in this Section must be different from the agent or attorney information listed in Section E, unless the attorney is an employee of the employer. For joint employer or master applications filed on behalf of more than one employer under, enter only the contact information for the main or primary employer (e.g., contact for an association filing as a joint employer) under the application.

1. Contact’s last (family) name *	2. First (given) name *		3. Middle name(s)
4. Contact’s job title *
5. Address 1 *
6. Address 2
7. City *		8. State *	9. Postal code *
10. Country *		11. Province
12. Telephone number *	13. Extension	14. E-Mail address

E. Attorney or Agent Information (If applicable)

1. Is/are the employer(s) represented by an attorney or agent in the filing of this application (including associations acting as agent under the H-2A program)? If “Yes”, complete Section E. *								 Yes  No
2. Attorney or Agent’s last (family) name §		3. First (given) name §				4. Middle name
5. Address 1 §
6. Address 2
7. City §			8. State §				9. Postal code §
10. Country §			11. Province
12. Telephone number §	13. Extension		14. E-Mail address
15. Law firm/Business name §					16. Law firm/Business FEIN §
17. State Bar number (only if attorney) §				18. State of highest court where attorney is in good standing (only if attorney) §
19. Name of the highest court where attorney is in good standing (only if attorney) §

F. Job Offer Information

a. Job Description

1. Job Title *
2. Number of hours of work per week Basic *: _______ Overtime: _______	3. Hourly Work Schedule * A.M. (h:mm): ___ : ____ P.M. (h:mm): ___ : ____
4. Does this position supervise the work of other employees? *  Yes  No		4a. If yes, number of employees worker will supervise (if applicable) § ______
5. Job duties – A description of the duties to be performed MUST begin in this space. If necessary, add attachment to continue and complete description. *

F. Job Offer Information (continued)

b. Minimum Job Requirements

1. Education: minimum U.S. diploma/degree required *  None  High School/GED  Associate’s  Bachelor’s  Master's  Doctorate (PhD)  Other degree (JD, MD, etc.)
1a. If “Other degree” in question 1, specify the diploma/ degree required §		1b. Indicate the major(s) and/or field(s) of study required § (May list more than one related major and more than one field)
2. Does the employer require a second U.S. diploma/degree? *			 Yes  No
2a. If “Yes” in question 2, indicate the second U.S. diploma/degree and the major(s) and/or field(s) of study required §
3. Is training for the job opportunity required? *			 Yes  No
3a. If “Yes” in question 3, specify the number of months of training required §	3b. Indicate the field(s)/name(s) of training required § (May list more than one related field and more than one type)
4. Is employment experience required? *			 Yes  No
4a. If “Yes” in question 4, specify the number of months of experience required §	4b. Indicate the occupation required §
5. Special Requirements - List specific skills, licenses/certifications, and requirements of the job opportunity. *

c. Place of Employment Information

1. Worksite address 1 *
2. Address 2
3. City *	4. County *
5. State/District/Territory *	6. Postal code *
7. Will work be performed in multiple worksites within an area of intended employment or a location(s) other than the address listed above? *	 Yes  No
7a. If Yes in question 7, identify the geographic place(s) of employment with as much specificity as possible. If necessary, submit an attachment to continue and complete a listing of all anticipated worksites. §

G. Rate of Pay

1. Basic Rate of Pay Offered * $ _____ . ____ $ _____ . ____ From: To (Optional):	1a. Overtime Rate of Pay (if applicable) § $ _____ . ____ $ _____ . ____ From: To (Optional):
2. Per: (Choose only one) *  Hour  Week  Bi-Weekly  Month  Year  Piece Rate
2a. If Piece Rate is indicated in question 2, specify the wage offer requirements: §
2b. For H-2B Applications ONLY, please enter the Prevailing Wage Determination tracking number (ETA Form 9141) *
3. Additional Wage Information (e.g., multiple worksite applications, itinerant work, or other special procedures). If necessary, add attachment to continue and complete description. §

H. Declaration of Employer and Attorney/Agent

In accordance with Federal regulations, the employer must attest that it will abide by certain terms, assurances and obligations as a condition for receiving a temporary labor certification from the U.S. Department of Labor. Applications that fail to attach Appendix A.2 or Appendix B.1 will be considered incomplete and not accepted for processing by the ETA application processing center.

1. For H-2A Applications ONLY, please confirm that you have read and agree to all the applicable terms, assurances and obligations contained in Appendix A.2. §	 Yes  No  N/A
2. For H-2B Applications ONLY, please confirm that you have read and agree to all the applicable terms, assurances and obligations contained in Appendix B.1. §	 Yes  No  N/A

I. Preparer

Complete this section if the preparer of this application is a person other than the one identified in either Section D (employer point of contact) or E (attorney or agent) of this application.

1. Last (family) name §	2. First (given) name §	3. Middle name
4. Job Title §
5. Firm/Business name §
6. E-Mail address §

J. U.S. Government Agency Use (ONLY)

Pursuant to the provisions of Section 101(a)(15)(h)(ii) of the Immigration and Nationality Act, as amended, I hereby certify that there are not sufficient U.S. workers who are qualified and who will be available to perform the temporary services or labor for which an employer desires to import foreign workers and the employment of the foreign workers will not adversely affect the wages and working conditions of U.S. workers similarly employed. By virtue of the signature below, the Department of Labor hereby acknowledges the following:

______________________________________________ ______________________________

Case number Receipt Date

______________________________________________ ______________________________

Case Status Total Worker Positions Certified

______________________________________________ ______________________________

Validity Period From Validity Period To

______________________________________________ ______________________________

Department of Labor, Office of Foreign Labor Certification Determination Date (date signed)

OMB Paperwork Reduction Act (1205-0466)

Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Public reporting burden for this collection of information is estimated to average 3 hours 20 minutes per response for H-2A and 2 hours 40 minutes for H-2B, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this data collection is required to obtain/retain benefits (Immigration and Nationality Act, 8 U.S.C. 1101, et seq.). Please send comments regarding this burden estimate or any other aspect of this information collection to the Office of Foreign Labor Certification * U.S. Department of Labor * Room C4312 * 200 Constitution Ave., NW, * Washington, DC * 20210 or by email [email protected]. Please do not send the completed application to this address.

ETA Form 9142 FOR DEPARTMENT OF LABOR USE ONLY Page 6 of 6

Case Number: ______________________ Case Status: __________________ Validity Period: ______________ to _______________