O
MB
Approval: 1205-0534
Expiration Date: 09/30/2019
Application for Prevailing Wage Determination
Form ETA-9141C
U.S.
Department of Labor
IMPORTANT: Employers and authorized preparers must read the general instructions carefully before completing the Form ETA-9141C. 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. Employment-Based Visa Information
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B. Requestor Point of Contact Information
1. Contact’s Last (family) Name * |
2. First (given) Name * |
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 (apartment/suite/floor and number) § |
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7. City * |
8. State *
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9.
Postal Code * |
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10. Country * |
11.
Province §
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12. Telephone Number * |
13.
Extension §
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14. Business Email Address *
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C. Employer Information
1. Legal Business Name *
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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 (apartment/suite/floor and number) § |
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5. City *
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6. State *
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7.
Postal Code * |
8. Country *
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9.
Province §
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10. Telephone Number *
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11. Extension § |
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12. Federal Employer Identification Number (FEIN from IRS) * |
13. NAICS Code *
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D. Job Opportunity Information
a. Job Description
1. Job Title *
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2a. Suggested SOC Occupation Title *
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a. Job Description (continued)
3. Job Title of Supervisor for this Position §
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4. Does this position supervise the work of other employees? * |
Yes No |
4a. If “Yes” to question 4, enter the number of employees worker will supervise. § |
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4b. If “Yes” to question 4, indicate the level of the employees to be supervised: § |
Subordinate Peer |
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5. Job duties – Please provide a description of the duties to be performed with as much 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. *
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6. Will travel be required in order to perform the job duties? *
Yes No |
6a. If “Yes” to question 6, please provide details of the travel required, such as area(s), frequency and nature of the travel. §
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b. Minimum Job Requirements
None High School/GED Associate’s Bachelor’s Master's Doctorate (PhD) Other degree (JD, MD, etc.) |
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1a. If “Other degree” in question 1, specify the U.S. diploma/ degree required. §
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1b. Indicate the major(s) and/or field(s) of study required. § (May list more than one related major and more than one field)
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Yes No |
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2a. If “Yes” in question 2, indicate the second U.S. diploma/degree and the major(s) and/or field(s) of study required. §
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b. Minimum Job Requirements (continued)
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Yes No |
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3a. If “Yes” in question 3, specify the number of months of training required. §
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3b. Indicate the field(s)/name(s) of training required. § (May list more than one related field and more than one type)
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Yes No |
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4a. If “Yes” in question 4, specify the number of months of experience required. §
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4b. Indicate the occupation(s) required. §
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c. Place of Employment Information
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Yes No |
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6a. If “Yes” in question 6, identify the specific geographic place(s) of employment where work will be performed. If necessary, submit a second completed Form ETA-9141C with a listing of the additional anticipated worksites. Please note that wages cannot be provided for unspecified/unanticipated locations. §
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E. Prevailing Wage Determination
FOR OFFICIAL GOVERNMENT USE ONLY |
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2. Date PW request received
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3. SOC (ONET/OES) code |
3a. SOC (ONET/OES) occupation title
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4
$
__________ . ____ |
4a. OES Wage level I II III IV N/A |
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5. Per: (Choose only one) Hour Week Bi-Weekly Month Year Piece Rate |
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5a. If Piece Rate is indicated in question 2, specify the wage offer requirements :*
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6. Prevailing wage source (Choose only one)
CNMI Governor’s Survey OES (Guam) OES (National Adjusted) |
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7. Additional Notes Regarding Wage Determination
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8. Determination date |
9. Expiration date
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Public Burden Statement (1205-0534)
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 46 minutes to complete the form, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the needed data, and completing and reviewing the collection of information. The obligation to respond to this data collection is required to obtain/retain benefits (Northern 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 Administration * Office of Foreign Labor Certification * 200 Constitution Ave., NW * Box PPII 12-200 * Washington, DC * 20210 or by email to [email protected]. Please do not send the completed application to this address.
Form
ETA-9141C FOR DEPARTMENT OF
LABOR USE ONLY Page
PW Tracking Number: __________________ Case Status: __________________ Determination Date: _____________ Validity Period: _____________ to _____________
File Type | application/msword |
Author | Melanie Shay |
Last Modified By | SYSTEM |
File Modified | 2019-10-02 |
File Created | 2019-10-02 |