Form ETA-9142A H-2A Application for Temporary Employment Certification

OMB Approval: 1205-0466
Expiration Date: XX/XX/XXXX

H-2A Application for Temporary Employment Certification
Form ETA-9142A
U.S. Department of Labor
IMPORTANT: Employers and authorized preparers must read the general instructions carefully before completing the Forms ETA-9142A and ETA-790/790A. A copy
of the instructions can be found at http://www.foreignlaborcert.doleta.gov/. If you are not submitting these forms 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 H-2A Application
1. Type of Employer Application (choose only one) *

 Individual Employer
 Association – Sole Employer
2.
3.
4.

 Joint Employer (2 or more individual employers)
 Association - Joint Employer

 Association - Agent
Is the employer operating as an H-2A Labor Contractor (H-2ALC), as defined by 20 CFR 655.103(b)? *
 Yes  No
Nature of Temporary Need (choose only one) *
 Seasonal  Other Temporary Need
Is a statement of temporary need attached to this application? *
 Yes  No

5. Is this application being filed with a request to waive the regulatory time period due to an
emergency situation, as defined by 20 CFR 655.134? *
6. If “Yes” is marked in question A.3, a statement justifying the employer’s emergency situation
is attached to this application. *

 Yes  No
 Yes  N/A

B. Employer Information
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) *

7. Postal Code *

13. NAICS Code *

C. Employer Point of Contact Information
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 *

Form ETA-9142A
H-2A Case Number: __________________

13. Extension §

14. Business Email Address *

FOR DEPARTMENT OF LABOR USE ONLY
Case Status: __________________

9. Postal Code *

Determination Date: _____________

Page 1 of 3
Validity Period: _____________ to _____________

OMB Approval: 1205-0466
Expiration Date: XX/XX/XXXX

H-2A Application for Temporary Employment Certification
Form ETA-9142A
U.S. Department of Labor
D. Attorney or Agent Information (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.
2. Attorney or Agent’s Last (family) Name §
3. First (given) Name §

 Attorney  Agent  None
4. Middle Name(s) §

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 §

If “Attorney” is marked in question D.1, complete questions 17 – 19 below.
17. State Bar Number(s) §
18. State of highest court where attorney is in good standing §
19. Name of the highest state court where attorney is in good standing §

If “Agent” is marked in question D.1, complete questions 20 and 21 below.
20. A copy of the current agreement or other documentation demonstrating the agent’s authority
to represent the employer in this application is attached to this application. §
21. A copy of the agent’s current Migrant and Seasonal Agricultural Worker Protection Act (MSPA)
Certificate of Registration identifying the farm labor contracting activities the agent is authorized to
perform is attached to this application. §

 Yes
 Yes 

N/A

 Yes
 Yes 

No

 Yes 

N/A

E. Job Opportunity & Supporting Documentation
1. SOC Occupational Code *

2. SOC Occupation Title *

3. A copy of the completed job order (Form ETA-790/790A) satisfying the requirements at
20 CFR 653, subpart F, and 20 CFR 655.122 is attached to this application. *
4. Did the employer conduct pre-filing recruitment as described in 20 CFR 655.123? *
5. If “Joint Employer” or “Association – Joint Employer” is marked in question A.1, the
Form ETA-790A and Addendum B identify the name(s), address(es), total number of workers
needed, and crops and agricultural work of each employer that will employ workers. §
For H-2A Labor Contractors ONLY
If “Yes” is marked in question A.2, complete questions E.5 through E.9 below
6. The Form ETA-790A, Addendum B, identifies the name(s) and location(s) of each fixed-site
agricultural business the employer will be providing H-2A workers, the expected first and last
dates of work for each business, and a description of crops and activities the workers will perform. §
7. A copy of fully-executed work contract(s) with each fixed-site agricultural business identified on
the Form ETA-790A, Addendum B, is attached to this application. §
8. A copy of the employer’s current MSPA Certificate of Registration identifying the farm labor
contracting activities the employer is authorized to perform is attached to this application. §
9. A surety bond meeting the requirements of 20 CFR 655.132(c) (i.e., Appendix B) is attached to this
application. §

Form ETA-9142A
H-2A Case Number: __________________

FOR DEPARTMENT OF LABOR USE ONLY
Case Status: __________________

Determination Date: _____________

 Yes
 Yes
 Yes 

N/A

 Yes
Page 2 of 3

Validity Period: _____________ to _____________

OMB Approval: 1205-0466
Expiration Date: XX/XX/XXXX

H-2A Application for Temporary Employment Certification
Form ETA-9142A
U.S. Department of Labor
10. Any of the fixed-site agricultural businesses provide workers with housing and/or transportation
between the place of employment and the living quarters under this application. §

 Yes 

No

F. Declaration of Employer 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 temporary
labor certification from the U.S. Department of Labor. Applications that fail to attach Appendix A will be considered incomplete and rejected without further review.

1. A signed and dated Appendix A for the employer identified in Section B of this application is
attached. *
2. Except for agricultural associations filing as a joint employer, a separate signed and dated
Appendix A for each employer identified as a joint employer on the job order (Form ETA-790/790A)
is attached. *

 Yes
 Yes 

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 D (attorney or agent)
of this application.

1. Last (family) Name §

2. First (given) Name §

4. Law Firm/Business FEIN §

3. Middle Initial §

5. Law Firm/Business Name §

6. Business Email Address §

Public Burden Statement (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 3.68 hours per response for all H-2A information collection requirements, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing, reviewing, and submitting 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.). Send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employment and
Training Administration, Office of Foreign Labor Certification, 200 Constitution Ave., NW, Suite PPII 12-200, Washington, DC, 20210. (Paperwork Reduction Project
OMB 1205-0466). DO NOT send the completed application to this address.

Form ETA-9142A
H-2A Case Number: __________________

FOR DEPARTMENT OF LABOR USE ONLY
Case Status: __________________

Determination Date: _____________

Page 3 of 3
Validity Period: _____________ to _____________