Form ETA 9142C ETA 9142C CW-1 Application for Temporary Employment Certification

OMB Approval: 1205-053X
Expiration Date: XX/XX/XXXX

CW-1 Application for Temporary Employment Certification
Form ETA-9142C
U.S. Departm ent of Labor

IMPORTANT: Employers and authorized preparers must read the general instructions carefully before completing the Form ETA-9142C. A copy of the instructions
can be found at http://www.foreignlaborcert.doleta.gov/. If you are not submitting this electronically, please complete ALL required fields/items containing an asterisk
(*) and any fields/items where a response is conditional as indicated by the section (§) symbol.

A. Nature of CW-1 Application



1. Type of Application (choose only one) *

New employment



Renew al of approved employment

2. CW-1 Perm it Renew al: If “Renew al of approved employment” is marked in Question A.1, enter
the date on w hich the CW-1 visa status of the nonimmigrant w orker(s) w ill expire. §
3. Long-Term Worker: Is the employer seeking to employ a long-term w orker w ho w as previously
issued a CW-1 visa or otherw ise granted CW-1 status, as defined in 20 CFR 655.402? *

 Yes

 No

4. Cap-Exem pt Worker: Will any of the CW-1 w orkers employed under this application be exempt
from the statutory numerical limit, or “cap,” on the total number of foreign nationals w ho may be
issued a CW-1 visa or otherw ise granted CW-1 status? *

 Yes

 No

5. Em ergency Situation: Is the employer requesting to w aive the requirement to obtain a valid PWD
prior to the filing of this application due to an emergency situation, as set forth in 20 CFR 655.422? *

 Yes

 No

FOR EMERGENCY SITUATIONS ONLY
If “Yes” is m arked in question A.5, m ark questions 6 and 7 below and include the required items.
6. A statement justifying the employer’s emergency situation is attached to this application. §



7. A completed Form ETA-9141, Application for Prevailing Wage Determination, is attached to this application. §



B. Em ployer Inform ation
1. Legal Business Name *
2. Trade Name/Doing Business As (DBA), if applicable §
3. Address 1 *
4. Address 2 (apartment/suite/floor and number) §
5. City *

6. State *

8. Country *

9. Province §

10. Telephone Number *

11. Extension §

12. Federal Employer Identification Number (FEIN from IRS) *

13. NAICS Code *

14. Type of Employer (Choose only one) *



Individual Employer

7. Postal Code *



Job Contractor – Joint Employer

FOR JOB CONTRACTORS ONLY
If “Job Contractor – Joint Em ployer” is m arked in question B.14, m ark questions 15 and 16 below
and include the required items.
15. A completed Appendix A identifying the employer-client is attached to this application. §



16. An executed contract or other agreement betw een the job contractor and the employer-client establishing a bona
fide relationship to the w orkers sought under this application is attached. §



Form ETA-9142C
CW-1 Case Number: __________________

FOR DEPARTMENT OF LABOR USE ONLY
Case Status: __________________

Determination Date: _____________

P age 1 of 5
Validity P eriod: _____________ to _____________

OMB Approval: 1205-053X
Expiration Date: XX/XX/XXXX

CW-1 Application for Temporary Employment Certification
Form ETA-9142C
U.S. Departm ent of Labor

C. Em ployer Point of Contact Inform ation
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 D, unless the attorney is an employee of the employer.

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 (apartment/suite/floor and number) §
7. City *

8. State *

10. Country *

11. Province §

12. Telephone Number *

13. Extension §

9. Postal Code *

14. Business Email Address *

D. Attorney or Agent Inform ation (If applicable)
1. Indicate the type of representation for the employer in the filing of this application. *
Complete the remainder of this section if “Attorney” or “Agent” is marked.

 Attorney  Agent  None

2. Attorney or Agent’s Last (family) Name §

4. Middle Name(s) §

3. First (given) Name §

5. Address 1 §
6. Address 2 (apartment/suite/floor and number) §
7. City §

8. State §

10. Country §

11. Province §

12. Telephone Number §

13. Extension §

9. Postal Code §

14. Law Firm/Business Email Address §

15. Law Firm/Business Name §

16. Law Firm/Business FEIN §

FOR ATTORNEY USE ONLY
If “Attorney” is m arked in question D.1, com plete questions 17 – 19 below .
17. State Bar Number(s) §
18. State of highest state court w here attorney is in good standing §
19. Name of the highest state court w here attorney is in good standing §
FOR AGENT USE ONLY
If “Agent” is m arked in question D.1, com plete question 20 below and include the required attachm ent.
20. A copy of the current agreement or other documentation demonstrating the agent’s authority to represent the
employer is attached to this application. §

Form ETA-9142C
CW-1 Case Number: __________________

FOR DEPARTMENT OF LABOR USE ONLY
Case Status: __________________



P age 2 of 5

Determination Date: _____________ Validity Period: _____________ to _____________

OMB Approval: 1205-053X
Expiration Date: XX/XX/XXXX

CW-1 Application for Temporary Employment Certification
Form ETA-9142C
U.S. Departm ent of Labor

E. Job Opportunity Inform ation
a. Occupational Classification and PWD
1. SOC Occupational Code *

2. SOC Occupation Title *

3. If “No” is marked to question A.5, enter the PWD case number obtained
from the U.S. Department of Labor for this job opportunity. *
b. Job Offer and Minim um Requirem ents
1. Job Title *
Period of Intended Em ploym ent

2. Workers
Needed *

3. Begin Date: *

4. End Date: *

5. Job Duties – Description of the specific services or labor to be performed. *

(All job duties must be disclosed on this form. One separate attachment will be accepted to fully complete the response.)

6. Anticipated days and hours of w ork per w eek (an entry is required for each box below) *

7. Hourly w ork schedule *

a. Total Hours

c. Monday

e. Wednesday

g. Friday

b. Sunday

d. Tuesday

f. Thursday

h. Saturday b. _____ : _____

a. _____ : _____






8. Education: minimum U.S. diploma/degree required. *

 None  High

School/GED

 Associate’s  Bachelor’s  Master's  Doctorate (PhD)  Other degree (JD,

9. Training: number of months required. *
11. Supervision: does this position supervise
the w ork of other employees? *

AM
PM
AM
PM
MD, etc.)

10. Work Experience: number of months required. *

 Yes
 No

11a. If “Yes” to question 11, enter the number of
employees w orker w ill supervise.§

12. Special Requirements - List specific skills, licenses/certifications, field(s) of training, and requirements of the job. *

Form ETA-9142C
CW-1 Case Number: __________________

FOR DEPARTMENT OF LABOR USE ONLY
Case Status: __________________

P age 3 of 5

Determination Date: _____________ Validity Period: _____________ to _____________

OMB Approval: 1205-053X
Expiration Date: XX/XX/XXXX

CW-1 Application for Temporary Employment Certification
Form ETA-9142C
U.S. Departm ent of Labor

c. Place of Em ploym ent and Wage Inform ation
1. Worksite Address *
2. Worksite Address § (apartment/suite/floor and number)
3. City *

4. State *

6. Basic Wage Rate Paid *
From:

6a. Overtime Wage Rate Paid §

$ ______ . ____ *

$ ______ . ____

To:

7. Per (Choose only one) *




Hour
Month




Week
Year

8. Frequency of Pay. *

5. Postal Code *




From:

$ ______ . ____

To:

$ ______ . ____

7a. Additional conditions about the w age rate to be paid. §
Bi-Weekly
Piece Rate

 Daily

 Weekly

 Biw eekly

 Other (specify):

________________________

9. Will w ork be performed at w orksite locations other than the one identified above? *
10. If “Yes” is marked in question E.c.9, a completed Appendix B is attached to this application. §

 Yes  No


d. Other Material Term s and Conditions of the Job Offer
1.

I have read and agree to provide the follow ing terms and conditions w ith this job offer as fully
explained in the Form ETA-9142C – General Instructions and at 20 CFR 655, Subpart E. *



Three-Fourths Guarantee: Workers w ill be offered employment for a total number of w ork hours equal to at least three
fourths of the w orkdays of the total period that begins w ith the first w orkday after the arrival of the w orker at the place of
employment or the advertised contractual first date of need, w hichever is later, and ends on the expiration date specified
in the w ork contract or in its extensions, if any.
Transportation and Subsistence: If the w orker completes 50 percent of the w ork contract period, the employer w ill
provide, reimburse, or advance payment for the w orker’s transportation and subsistence from the place of recruitment to
the place of w ork. Upon completion of the w ork contract or w here the w orker is dismissed earlier, the employer w ill
provide or pay for the w orker’s reasonable costs of return transportation and subsistence back home or to the place the
w orker originally departed to w ork, except w here the w orker w ill not return due to subsequent employment w ith another
employer or w here the employer has appropriately reported a w orker’s voluntary abandonment of employment. The
amount of transportation payment or reimbursement w ill be equal to the most economical and reasonable common carrier
for the distances involved.



 Yes  No

Daily Transportation: Workers w ill be provided w ith daily transportation to and from the w orksite in
compliance w ith all applicable Federal and Commonw ealth law s and regulations. *

 Yes  N/A

3. Overtim e Available: Overtime hours w ill be available to the w orker under this job offer and payable
for every hour w orked at the rate disclosed in this application. *

 Yes  N/A

4. On-the-Job Training Available: Workers w ill be provided w ith on-the-job training to perform the
duties assigned. *

 Yes  N/A

5. Em ployer-Provided Tools and Equipm ent: Workers w ill be provided, w ithout charge or deposit
charge, all tools, supplies, and equipment required to perform the duties assigned. *

 Yes  N/A

2.

6. Board, Lodging, or Other Facilities: Workers w ill be provided w ith board, lodging, or other
facilities and/or the employer w ill assist w orkers in securing board, lodging, or other facilities. *
7. Deductions From Pay: State all deduction(s) from pay and, if know n, the amount(s). *

Form ETA-9142C
CW-1 Case Number: __________________

FOR DEPARTMENT OF LABOR USE ONLY
Case Status: __________________

 Yes  N/A

P age 4 of 5

Determination Date: _____________ Validity Period: _____________ to _____________

OMB Approval: 1205-053X
Expiration Date: XX/XX/XXXX

CW-1 Application for Temporary Employment Certification
Form ETA-9142C
U.S. Departm ent of Labor

e. Recruitm ent Information
1. Explain how prospective applicants may be considered for employment under this job opportunity, including verifiable
methods of contacting the employer, and the days and hours applicants can apply for the job. *

2. Telephone Number to Apply *

3. Email Address to Apply *

4. Website address (URL) to Apply *

F. Declaration of Em ployer and Attorney/Agent

In accordance with Federal regulations, the employer(s) must attest to abide by certain terms, assurances, and obligations as a condition for receiving a t e mp o r a r y
labor certification from the U.S. Department of Labor. Applications that fail to attach Appendix B will not be certified by the Department.

1. Please confirm that you have read and agree to all the applicable terms, assurances, and
obligations contained in Appendix C and have attached a signed and dated copy of Appendix C
w ith this application. *
2. Please confirm that the employer-client identified in Appendix A has read and agrees to all the
applicable terms, assurances, and obligations contained in Appendix C and has attached a
separate signed and dated copy of Appendix C w ith this application. *

 Yes  No
 Yes  No  N/A

G. Preparer

Complete this section if the preparer of this application is a person other than the one identified in either Section C (employer point of contact) or Section D (attor n e y
or agent) of this application.

1. Last (family) Name §
4. Law Firm/Business FEIN §

2. First (given) Name §

3. Middle Initial §

5. Law Firm/Business Name §

6. Law Firm/Business Email Address §

Public Burden Statement (1205-053X)
Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. P u b lic re p o rt in g
burden for this collection of information is estimated to average 1 hour and 50 minutes to complete the form and its appendices, i n c l ud in g t h e
time for reviewing instructions, searching existing data sources, gathering and maintaining the needed data, and completing and revi ewi ng t h e
collection of information. The burden estimate is as follows: 9142C - 45 minutes, Appendix A - 15 minutes, Appendix B - 20 minutes, Appendix C
- 20 minutes, and recordkeeping - 10 minutes. The obligation to respond to this data collection is required to obtain/retain b e ne f it s (No rt h e rn
Mariana Islands U.S. Workforce Act of 2018, 48 U.S.C. 1806 et seq.). Please send comments regarding this burden estimate or any other
aspect of this information collection to the U.S. Department of Labor * Employment and Training Admin ist ra t i on * O f f i ce o f Fo re i gn L a b or
Certification * 200 Constitution Ave., NW * Box PPII 12-200 * Washington, DC * 20210 or by email to [email protected] ov . P l ea se do
not send the completed application to this address.
Form ETA-9142C
CW-1 Case Number: __________________

FOR DEPARTMENT OF LABOR USE ONLY
Case Status: __________________

P age 5 of 5

Determination Date: _____________ Validity Period: _____________ to _____________