ETA-9142C Appendix B

OMB Approval: 1205-0534

Expiration Date: 10/31/2021

CW-1 Application for Temporary Employment Certification

Form ETA-9142C - Appendix B

U.S. Department of Labor

City *	Postal/ZIP Code *	Additional Place of Employment Information § (Address—e.g., street address, area, town, village, geographic identification)	Additional Work Itinerary Information §
			Crew ID	Total Workers	Begin Date	End Date	Basic Wage Rate (in $)		Per
							From:	To:

For the public burden statement, please see the Form ETA-9142C, General Instructions.

Form ETA-9142C -Appendix B FOR DEPARTMENT OF LABOR USE ONLY Page B.1 of B.1

CW-1 Case Number: ____________________ Case Status: _______________________ Determination Date: _____________ Validity Period: _____________ to _____________