ETA Form 9142 - Ap Application for Temporary Employment Certification - App

OMB Control Number: 1205-0466
Expiration Date: 04/30/2012

Application for Temporary Employment Certification
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For Use in Filing Applications Under the H-2B Non-Agricultural Program ONLY
A. Attorney or Agent Declaration
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fine or 5 years in a Federal penitentiary or both (18 U.S.C. 1001).

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B. Employer Declaration
By virtue of my signature below, ,+(5(%<&(57,)<the following conditions of employment:


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ETA Form 9142 – Appendix B.1
Case Number:

FOR DEPARTMENT OF LABOR USE ONLY
Case Status:

Period of Employment:

Page B.1 of B.2
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OMB Control Number: 1205-0466
Expiration Date: 04/30/2012

Application for Temporary Employment Certification
ETA Form 9142 – APPENDIX B.1
U.S. Department of Labor
9.

The employer and its agents and/or attorneys have not sought or received payment of any kind from the employee for any
activity related to obtaining labor certification, including payment of the employer's attorneys' fees, application fees, or
recruitment costs. For purposes of this paragraph, payment includes, but is not limited to, monetary payments, wage
concessions (including deductions from wages, salary, or benefits), kickbacks, bribes, tributes, in kind payments, and free
labor.

10. Unless the H-2B worker is being sponsored by another subsequent employer, the employer will inform H-2B workers of the
requirement that they leave the U.S. at the end of the period certified by the Department or separation from the employer,
whichever is earlier, as required under § 655.35, and that if dismissed by the employer prior to the end of the period, the
employer is liable for return transportation.
11. Upon the separation from employment of any foreign worker(s) employed under the labor certification application, if such
separation occurs prior to the end date of the employment specified in the application, the employer will notify the Department
and DHS in writing or any other method specified of the separation from employment not later than forty-eight (48) hours after
such separation is discovered by the employer.
12. The employer will not place any H-2B workers employed pursuant to this application outside the area of intended employment
listed on the Application for Temporary Employment Certification unless the employer has obtained a new temporary labor
certification from the Department.
13. The dates of temporary need, reason(s) for temporary need, and number of worker positions being requested for certification
have been truly and accurately stated on the application.
14. If the application is being filed as a job contractor, the employer will not place any H-2B workers employed pursuant to the
labor certification application with any other employer or at another employer’s worksite unless:
(i)

(ii)

The employer applicant first makes a bona fide inquiry as to whether the other employer has displaced or intends to
displace a similarly employed U.S. worker within the area of intended employment within the period beginning 120
days before and throughout the entire placement of the H-2B worker, the other employer provides written
confirmation that it has not so displaced and does not intend to displace such U.S. workers; and
All worksites are listed on the certified Application for Temporary Employment Certification

I hereby designate the agent or attorney identified in section D (if any) of the ETA Form 9142 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 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

ETA Form 9142 – Appendix B.1
Case Number:

6. Date signed

FOR DEPARTMENT OF LABOR USE ONLY
Case Status:

Period of Employment:

Page B.2 of B.2
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