ETA-9141 Application for Prevailing Wage Determination

Sample Revised PW 9141 Wire Frames
Step 1 of 7
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A. Employment-Based Visa Information
1. Indicate the type of visa
classification supported by this
application:

* Please select a visa classification

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B. Requestor Point-of-Contact Information
1. Contact’s last (family) name

*

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2. First (given) name

*

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3. Middle name(s)

*

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4. Contact’s job title

*

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5. Address 1

*

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6. Address 2
7. City

*

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8. State

*

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9. Postal code

*

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10. Country

*

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11. Province (if applicable)
12. Telephone number

*

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13. Extension

*

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14. Fax Number

*
*

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15. E-Mail Address

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Figure 6. Step 1 - Sample Only

Sample Revised PW 9141 Wire Frames
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C. Employment Information
*

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2. Trade name/Doing Business As §
(DBA), if applicable

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3. Address 1

*

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4. Address 2

*

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5. City

*

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6. State

*

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7. Postal code

*

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8. Country

*

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9. Province (if applicable)

*

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10. Telephone number

*

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11. Extension

*

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1. Legal business name

12. Federal Employer Identification
Number (FEIN from IRS)
*
13. NAICS code
*
(must be at least 4-digits)

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Figure 7. Step 2 - Sample Only

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Form 9141 – Step 3 of 7 Case PW-400-12345-123456 (STATUS)
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D. Wage Processing Information
1. Is the employer covered by
ACWIA?*

2. Is the position covered by a
Collective Bargaining Agreement
(CBA)?*

*

Yes

No

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*

Yes

No

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Yes

No

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DBA

SCA

Yes

No

3. Is the employer requesting
consideration of Davis-Bacon
(DBA) or McNamara Service
Contract (SCA) Acts?*

*

4. Is the employer requesting
consideration of a survey in
determining the prevailing wage?*

*

4a. Survey Name:* §

*

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4b. Survey Date of Publication:* §

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*

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Figure 8. Step 3 - Sample Only

Sample Revised PW 9141 Wire Frames
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Form 9141 – Step 4 of 7 Case PW-400-12345-123456 (STATUS)
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E. Job Offer Information
a. Job Description
1. Job Title

*

2. SOC (ONET/OES) Code

*

2 a. SOC (ONET/OES)
Occupation Title

*

3. Job Title of Supervisor for this
position (if applicable)

§

4. Does this position supervise
The work of other employees?

*

Search SOC/O*NET (OES) Code

Yes
No

4a. If “Yes”, number of employees
worker will supervise (if applicable) §

4b. If “Yes”, please indicate the level
of the employees to be supervised:

Subordinate
Peer

5. Job duties – Please provide a
description of the duties to be
performed with as mush specificity
as possible, including details
regarding the areas/fields and/or
products/industries involved. A
*
description of the job duties to be
performed MUST begin in this
space. If necessary, add
attachment to continue and
complete description.
6. Will travel be required in order
To perform the job duties?

*

Yes
No

6a. If “Yes”, please provide details
of the travel required, such as
area(s), frequency and nature of
the travel.

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Figure 9: Step 4 - Sample only

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E. Job Offer Information (cont.):
b. Minimum Job Requirements
1. Education: minimum U.S.
diploma/degree required

*

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1 a. If “Other degree”, specify the §
diploma/degree required

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1 b. Indicate the major(s) and/or §
field(s) of study required (May list
more than one related major and
more than one filed)

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2. Does the employer require a
second U.S. diploma/degree?

*

Yes

?

No
Clear
2 a. If “Yes”, 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?

*

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Yes

?

No
Clear
3 a. If “Yes”, specify the number
of months of training required

§

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3 b. 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?

*

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Yes

?

No
Clear
4 a. If “Yes”, specify the number
of months of experience required

§

4 b. Indicate the occupation
required

§

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5. Special Requirements – List
*
specific skills, licenses/certificates/
certifications, and requirements of
the job opportunity

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E. Job Offer Information (cont.)
c. Place of Employment Information
*
1. Worksite address 1

*

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2. Address 2

*

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4. County

*

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5. State/District/Territory

*

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6. Postal code

*

3. City

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
Clear

7 a. If Yes, identify the geographic place(s) of employment indicating each metropolitan
statistical area (MSA) or the independent city(ies)/township(s)/county(ies)(borough(s)/
parish(es)) and the correspondence state(s) where work will be performed. If necessary,
submit an attachment to continue and complete a listing of all anticipated worksites. Please
note that wages cannot be provided for unspecified/unanticipated locations. §
Select a State/Territory

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County/Township
BLS Areas
Other
Add Worksite

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Additional Worksite(s)
State

Area Basis

Area

0 Row(s)

Delete Selected Worksite(s)

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Figure 11. Step 6 - Sample Only

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Sample Revised PW 9141 Wire Frames
Generated Section F of the Form 9141

FOR OFFICIAL GOVERNMENT USE ONLY
1.
PW tracking number
3. SOC (ONET/OES) code

4. Prevailing wage $_______________

2. Date PW request received
3a. SOC (ONET/OES) occupation title
4a. OES Wage level
 I
 II
 III
 N/A

 IV

5. Per: (Choose only one)
 Week  Bi-Weekly  Month  Year  Piece Rate
5a. If Piece Rate is indicated in question 2, specify the wage offer requirements :*
6.

Prevailing wage source (Choose only one)

 OES (All Industries)

 OES (ACWIA – Higher Education)

 CBA

 DBA

 SCA

 Other/Alternate Survey

6a. If “Other/Alternate Survey” in question 7, specify
7. Additional Notes Regarding Wage Determination

8. Determination date

9. Expiration date

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