OMB Approval: 1205-0466
Expiration
Date: 08/31/2022
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
https://www.dol.gov/agencies/eta/foreign-laborhttp://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.
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2. Is the employer operating as an H-2A Labor Contractor (H-2ALC), as defined by 20 CFR 655.103(b)? * |
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3. Nature of Temporary Need (choose only one) * |
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4. Is a statement of temporary need attached to this application? * |
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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? * |
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6. Is a statement justifying the employer’s emergency situation attached to this application? * |
Yes No N/A |
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 * |
6. State * |
7. Postal Code * |
8. Country * |
9. Province § |
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10. Telephone Number * |
11. Extension § |
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12. Federal Employer Identification Number (FEIN from IRS) * |
13. NAICS Code * |
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) § |
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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 * |
9. Postal Code * |
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10. Country * |
11. Province § |
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12. Telephone Number * |
13. Extension § |
14. Business Email Address * |
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. |
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2. Attorney or Agent’s Last (family) Name § |
3. First (given) Name § |
4. Middle Name(s) § |
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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 § |
9. Postal Code § |
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10. Country § |
11. Province § |
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12. Telephone Number § |
13. Extension § |
14. Law Firm/Business Email Address § |
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15. Law Firm/Business Name § |
16. Law Firm/Business FEIN § |
If “Attorney” is marked in question D.1, complete questions 17 to 19 below. |
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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. |
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20. Is a copy of the current agreement or other documentation demonstrating the agent’s authority to represent the employer in this application attached? § |
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21. Is 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 attached to this application? § |
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1. SOC Occupational Code * |
2. SOC Occupation Title * |
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3. Is 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 attached to this application? * |
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4. If “Joint Employer” or “Association – Joint Employer” is marked in question A.1, does the Form ETA-790A identify the name, address, total number of workers needed, and crops and agricultural work of each employer that will employ workers? § |
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For H-2A Labor Contractors ONLY If “Yes” is marked in question A.2, complete questions E.5 through E.9 below |
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5. Does the Form ETA-790A identify the name(s) and location(s) of each fixed-site agricultural business the employer will be providing H-2A workers, the expected beginning and end dates, and a description of crops and activities the workers will perform? § |
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6. Is a copy of fully-executed work contract(s) with each fixed-site agricultural business identified on the Form ETA-790A attached to this application? § |
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7. Is a copy of the employer’s current MSPA Certificate of Registration identifying the farm labor contracting activities the employer is authorized to perform attached to this application? § |
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8. Is a surety bond meeting the requirements of 20 CFR 655.132(b)(3) attached to this application?§ |
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9. Will any of the fixed-site agricultural businesses provide workers with housing and/or transportation between the worksite and the living quarters under this application? § |
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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 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 A and have attached a signed and dated copy of Appendix A with this application. * |
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2. Except for agricultural associations filing as a joint employer, please confirm that each employer filing as a joint employer on the job order (Form ETA-790/790A) has read and agree to all the applicable terms, assurances and obligations contained in Appendix A and has attached a separate signed and dated copy of Appendix A with this application. * |
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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 § |
3. Middle Initial § |
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4. Law Firm/Business FEIN § |
5. Law Firm/Business Name § |
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6. Business Email Address § |
For public burden statement information, please see Form ETA-9142A, General Instructions.
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
3.66
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
Page
Case
Status:
Determination
Date: Validity
Period: to _
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | H-2A Application for Temporary Employment Certification Form ETA-9142A |
Author | Melanie Shay |
File Modified | 0000-00-00 |
File Created | 2023-08-28 |