Form 750A Form 750A Application for Alien Employment Certification

OMB Approval No. 1205-0015
U.S. DEPARTMENT OF LABOR
Employment and Training Administration

Expires:XX/XX/XXXX

IMPORTANT: READ CAREFULLY BEFORE COMPLETING THIS FORM
PRINT legibly in ink or use a typewriter. If you need more space to
answer questions in this form, use a separate sheet. Identify each answer
with the number of the corresponding question. SIGN AND DATE each
sheet in original signature.
To knowingly furnish any false information in the preparation of this form
and any supplemental thereto or to aid, abet, or counsel another to do so is
a felony punishable by $10,000 fine or 5 years in the penitentiary, or both
(18 U.S.C. 1001)

APPLICATION
FOR
ALIEN EMPLOYMENT CERTIFICATION

PART A. OFFER OF EMPLOYMENT
1. Name of Alien

(Family name in capital letter, First, Middle, Maiden)

2. Present Address of Alien

3. Type of Visa (if in U.S.)

(Number, Street, City and Town, State ZIP code or Province, Country)

The following information is submitted as an offer of employment
4. Name of Employer
(Full name of Organization)

5. Federal Taxpayer ID -- EIN

6. Address

(Number, Street, City and Town, State ZIP code)

7. Address Where Alien Will Work

(if different than Item 6)

8. Nature of Employer’s Business
Activity

9. Name of Job Title

10. Total Hours Per Week
a. Basic

b. Overtime

11. Work
Schedule

12. Rate of Pay

(Hourly)
a.m.
p.m.
13. Describe Fully the job to be Performed

a. Basic

b. Overtime

$

$

per ________

per ________

(Duties)

14. State in detail the MINIMUM education, training, and experience for a
worker to perform satisfactorily the job duties described in item 13
above.
Grade
High
College
College Degree Required
EDUSchool
School
CATION
(Enter
Major Field of Study
number of

15. Other Special Requirements

(specify)

years)
No. Yrs.

No. Mos.

Job Offered

Related
Occupation

TRAINING

EXPERIENCE

Yrs.

Number
Mos.
Yrs.

Type of Training

Related Occupation

(specify)

Mos.

16. Occupational Title of
Person Who Will Be
Alien’s Immediate Supervisor

17. Number of
Employees
Alien Will Supervise
ENDORSEMENTS
(Make no entry in section – for Government use only)
Date Forms Received
L.O.

S.O.

R.O.

N.O.

Ind. Code

Occ. Code

Occ. Title
ETA 750 (Nov. 2007)

OMB Control No. 1205-0015

a. No. of Openings To Be
Filled by Aliens
Under Job Offer

a. Number
of
Local

b. Exact Dates You Expect
To Employ Alien
From

Expires: XX/XX/XXXX

19. IF JOB IS UNIONIZED (Complete)

18. COMPLETE ITEMS ONLY IF JOB IS TEMPORARY

To

b. Name of Local

c. City and State

20. STATEMENT FOR LIVE-AT-WORK JOB OFFERS
a. Description of Residence
Number of
Rooms

(“X” one)
 House


(Complete for Private Household ONLY)

b. No. Persons residing at Place of Employment
Adults

Children
BOYS

Apartment

(“X” one)

c. Will free board and private
room not shared with anyone be provided?

Ages

 YES

 NO

GIRLS

21. DESCRIBE EFFORTS TO RECRUIT U.S. WORKERS AND THE RESULTS. (Specify Sources of Recruitment by Name)

22. Applications require various types of documentation. Please read Part II of the instructions to assure that appropriate

supporting documentation is included with your application.
23. EMPLOYER CERTIFICATIONS
By virtue of my signature below, I HEREBY CERTIFY the following conditions of employment.
a.

I have enough funds available to pay the wage
or salary offered the alien.

b.

The wage offered equal or exceeds the prevailing wage and I guarantee that, if a labor certification is granted, the wage paid to the alien when
the alien begins work will equal or exceed the prevailing wage which is applicable at the time the
alien begins work.

c.

d.

e.

The job opportunity does not involve unlawful discrimination by race, creed, color, national origin, age,
sex, religion, handicap, or citizenship.

f.

The job opportunity is not:
(1)

Vacant because the former occupant is on
strike or is being locked out in the course of
a labor dispute involving a work stoppage.

(2)

At issue in a labor dispute involving a work
stoppage.

The wage offered is not based on commissions,
bonuses, or other incentives, unless I guarantee
a wage paid on a weekly, bi-weekly, or monthly
basis.

g.

The job opportunity’s terms, conditions and occupational environment are not contrary to Federal,
State or local law.

I will be able to place the alien on the payroll
on or before the date of the alien’s proposed
entrance into the United States.

h.

The job opportunity has been and is clearly open to
any qualified U.S. worker.

24. DECLARATIONS
DECLARATION
OF
EMPLOYER
SIGNATURE

NAME

(Type or Print)

EMAIL ADDRESS

Pursuant to 28 U.S.C. 1746, I declare under penalty of perjury the foregoing is true and correct.
DATE

TITLE

CONTACT TELEPHONE

AUTHORIZATION OF
AGENT OF EMPLOYER

I HEREBY DESIGNATE the agent below to represent me for the purposes of labor certification and I TAKE FULL
RESPONSIBILITY for accuracy of any representations made by my agent.

SIGNATURE OF EMPLOYER

NAME OF AGENT

EMAIL ADDRESS

(Type or Print)

FAX TELEPHONE

DATE

ADDRESS OF AGENT

CONTACT TELEPHONE

(Number, Street, City, State, ZIP code)

FAX TELEPHONE

OMB No.: 1205-0015 OMB Expiration Date: XX/XX/XXXX. OMB Burden Hours averages 2.8 hours. OMB Burden Statement: These reporting instructions have been approved under the Paperwork
Reduction Act of 1995. Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Obligations to reply are mandatory. (Title 8 U.S.C. §§
1882, 1884, and 1188) Public reporting burden for this collection of information, which is to assist with planning and program management, includes the time to review instructions, search existing data
sources, gather and maintain the data needed, and complete and review the collection of information. 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, Room 12-200, 200 Constitution Ave. NW, Washington, DC 20210. (Paperwork Reduction Project OMB 1205-0015.)

PRIVACY ACT STATEMENT
In accordance with the Privacy Act of 1974, as amended (5 U.S.C. 552a), you are hereby notified that the information provided herein is protected
under the Privacy Act. The Department of Labor (DOL) is maintaining a System of Records titled Employer Application and Attestation File for
Permanent and Temporary Alien Workers (DOL /ETA-7).
Case files developed in processing labor certification applications, labor condition applications, or labor attestations, may be released to the
employers which filed such applications, their representatives, and to named alien beneficiaries or their representatives, if requested, to
review Employment and Training Administration (ETA) actions in connection with appeals of denials before the DOL Office of Administrative
Law Judges and federal courts; to participating agencies such as the DOL Office of Inspector General, Employment Sta ndards
Administration. Department of Ho meland Security 's U.S., Citizenship and Immigration Services and Bureau of Immigration and Customs
Enforcement, and Department of State in connection with administering and enforcing related immigration laws and regulations; and to the
DOL Office of Administrative Law Judges and Federal Courts in connection with appeals of denials of labor certification requests, labor
condition applications, and labor attestations.
Further disclosures may be made under the following circumstances: in connection with federal litigation; for law enforcement purposes; to
authorized parent locator persons under Pub. L. 93 -647; to an information source in connection with personnel, procurement, or
benefit-related matters, to a contractor o r their employees, consultants, grantees or their employees, or volunteers who have been engaged
to assist the agency in the performance of a contract; for Federal debt collection purposes: the Office of Management and Budget in
connection with its legislative review, coordination, and clearance activities; if a person about whom this record is maintained submits a
written request to a Member of Congress or their staff and that request is forwarded to the Department, we may release the information to
the Me mber of Congress or Congressional staff in response to the inquiry made on behalf of the subject of the record: and to the news
media and the public when a matter under investigation becomes public knowledge, the Solicitor of Labor determines the disclosure is
necessary to preserve confidence or integrity of the Department, or the Solicitor of Labor determines that a legitimate public interest exists in
the disclosure of information unless the disclosure would constitute an unwarranted invasion of personal privacy.