Tracked 9141

OMB Approval: 1205-0508 Expiration Date: XX/XX/XXXX

Application for Prevailing Wage Determination Form ETA-9141

U.S. Department of Labor

Please read and review the filing instructions carefully before completing the Form ETA-9141. A copy of the instructions can be found on the Office of Foreign Labor Certification website at https://www.dol.gov/agencies/eta/foreign-labor. For all submissions, either electronic or paper, ALL required fields/items containing an asterisk (*) must be completed as well as any applicable fields/items where a response is conditional as indicated by the section (§) symbol.

1. Employment-Based Visa Information

2. Employer Point-of-Contact Information

Important note: The information contained in this section is for an employee authorized to act on behalf of the employer in labor certification or labor condition application matters. The information in this section must be different from the attorney or agent information listed in Section D, except when an attorney listed in Section D is an employee of the employer.

1. Contact’s last (family) name *	2. First (given) name *		3. Middle name(s) (if applicable) §
4. Contact’s job title *
5. Address 1 *
6. Address 2
7. City *		8. State §	9. Postal code *
10. Country *		11. Province (if applicable) §
12. Telephone number *	13. Extension (if applicable) §	14. Business e-mail address *

3. Employer Information

1. Legal business name *
2. Trade name/Doing Business As (DBA), if applicable §
3. Address 1 *
4. Address 2
5. City *	6. State §	7. Postal code *
8. Country *	9. Province (if applicable) §
10. Telephone number *	11. Extension (if applicable) §
12. Federal Employer Identification Number (FEIN from IRS) *	13. NAICS code *

4. Attorney or Agent Information (if applicable)

1. Indicate the type of representation for the employer in the filing of this application * If D.1 is “Attorney” or “Agent” the remainder of this section is required		Attorney  Agent  None
2. Attorney or agent’s last (family) name §	3. First (given) name §	4. Middle name(s) §
5. Address 1 §

6. Address 2 (apartment/suite/floor and number)
7. City §		8. State §	9. Postal code §
10. Country §		11. Province (if applicable) §
12. Telephone number §	13. Extension §	14. Law firm/business e-mail address §
15. Law firm/business name §		16. Law firm/business FEIN §

5. Wage Source Information

Refer to instructions for all supporting documents required in this section.

1. Is the employer covered by ACWIA, as described in 20 CFR 656.40(e)(1)? * (Not applicable for H-2B)		Yes	No		N/A
a. If “Yes,” identify which ACWIA provision the employer is covered under (choose all that apply): § (i) Institution of higher education (ii) Affiliated or related nonprofit entity connected or associated with an institution of higher education (iii) Nonprofit research organization or Governmental research organization
b. If the employer has previously been determined not covered under ACWIA, does the employer have any reason to believe that its status has changed? §		Yes	No		N/A
2. Is the position covered by a professional sports league rules or regulations? §		Yes	No
3. Is the position covered by a Collective Bargaining Agreement (CBA)? §		Yes	No		N/A
4. Is the employer requesting a prevailing wage based on the Davis-Bacon Act (DBA) or McNamara Service Contract Act (SCA) (Not applicable for H-2B)? *		Yes	No
a. If “Yes,” identify which wage source the employer is requesting: §
DBA	SCA
5. Is the employer requesting consideration of a survey as a wage source in determining the prevailing wage? *		Yes		No
If “Yes,” 5.a and 5.b must be completed(If this is a request to use a survey in the H-2B program, Form ETA-9165 must also be completed.) .
a. Survey name or title: §
b. Survey date of publication or, if not published, date of submission to DOL: §

6. Job Offer Information

   1. Job Description

1. Job title *
2. Job duties: Description of the specific services or labor to be performed. * (All job duties must be disclosed. A description of the job duties MUST begin in this space. For mail-in applications, an addendum may be used to complete the response fully.)
3. Does this position supervise the work of other employees? *	Yes	No
a. If “Yes,” please indicate the SOC code(s) and SOC title(s) of the occupation(s) of the employees to be supervised: §

2. Minimum Job Requirements

1. Education: Minimum U.S. degree required *
None	High school/GED	Associate’s	Bachelor’s	Master’s	Doctorate (Ph.D.)	Other degree (J.D., M.D., etc.)
a. If “Other degree” in question 1, specify the U.S. degree required §				b. Indicate the major(s) and/or field(s) of study required § (May list more than one related major and more than one field)
2. Does the employer require a second U.S. degree? *				Yes			No
a. If “Yes” in question 2, indicate the second U.S. degree and the major(s) and/or field(s) of study required §
3. Is training for the job opportunity required? *				Yes			No
a. If “Yes” in question 3, specify the number of months of training required §				b. Indicate the field(s)/name(s) of training required § (May list more than one related field and more than one type)
4. Is employment experience required? *				Yes			No
a. If “Yes” in question 4, specify the number of months of experience required §				b. Indicate the occupation required §
5. Special skills or other requirements: Does the employer require any specific or other requirements? *				Yes			No
a. If “Yes,” check all that apply and specify the requirement(s): § (i) License/Certification:
(ii) Foreign language:
(iii) Residency/Fellowship:
(iv) Other special skills or requirements:

3. Alternative Job Requirements

While an employer may specify alternative requirements, the substantial equivalency of the alternative requirements to minimum requirements will not be evaluated. (Not applicable for H-2B)

1. Are alternate sets of education, training, and/or experience accepted? §					Yes				No
If c.1 is “Yes,” c.2, c.3, and c.4 must be completed.
2. Specify the alternate level of education: U.S. degree accepted §
None	High school/GED	Associate’s	Bachelor’s	Master’s		Doctorate (Ph.D.)	Other degree (J.D., M.D., etc.)
a. If “Other degree” in question 2, specify the U.S. degree accepted §					b. Indicate the major(s) and/or field(s) of study accepted § (May list more than one related major and more than one field)
3. Is alternate training for the job opportunity accepted? §					Yes					No
a. If “Yes” in question 3, specify the number of months of alternate training accepted §					b. Indicate the field(s)/name(s) of training accepted § (May list more than one related field and more than one type)
4. Is alternate employment experience accepted? §					Yes					No
a. If “Yes” in question 4, specify the number of months of alternate experience accepted §
5. Special skills or other requirements: Does the employer require any specific or other requirements? *								Yes		No
a. If “Yes,” check all that apply and specify the requirement(s) §
(i) License/Certification:
(ii) Foreign language:
(iii) Residency/Fellowship:
(iv) Other special skills or requirements:

4. Other Information

1. Suggested SOC (O*NET/OEWS) code *	a. Suggested SOC (O*NET/OEWS) occupation title *
2. Job title of the official the employee will report to for this job opportunity (if applicable) §
Will travel be required in order to perform the job duties? * Yes  No	a. If “Yes,” provide geographic location and frequency of the travel §

4. Place of Employment Information

1. Worksite address 1 *
2. Address 2
3. City *	4. State *	5. County *	6. Postal code *
7. Will work be performed in any Bureau of Labor Statistics Area (Metropolitan or Non-Metropolitan Statistical Areas) other than the Bureau of Labor Statistics Area of the address listed above, or, in the case of Bureau of Labor Statistics areas with multiple county-level prevailing wage rates, in a county other than the county of the address listed above? * (If “Yes,” a completed Appendix A is required)				Yes  No

7. Prevailing Wage Determination

FOR OFFICIAL GOVERNMENT USE ONLY

1. PWD tracking number:

2. PW receipt date:

3. SOC code:

a. SOC occupation title:

While all prevailing wages are issued at the six-digit SOC code level, O*NET includes extended eight-digit occupations. If applicable, the O*NET eight-digit extension code is listed below.

b. O*NET code:

c. O*NET occupation title:

When the job opportunity represents a combination of occupations, listed below are the other occupations.

d. O*NET code:

e. O*NET occupation title:

4. Prevailing wage: (based on the primary worksite location. See Item 6 below for details). For H-1B, H-1B1, E-3, and PERM only, this wage is based on the minimum job requirements for the position. $ .

a. Per: (Choose only one)

b. OEWS wage level:

Hour

Week

Bi-Weekly

Month

Year

I

II

III

IV

OEWS mean

N/A

c. Prevailing wage source (Choose only one):

d. If “Survey” in question 4.c, specify the name of the survey:

OEWS (All Industries)

OEWS (ACWIA)

CBA

DBA

SCA

Alternate survey

Professional sports league rules or regulations

5. Prevailing wage: (based on the primary worksite location. See Item 6 below for details). For H-1B, H-1B1, E-3, and PERM only. This wage is based on the alternative job requirements for the position (does not apply to H-2B). $ .

a. Per: (Choose only one)

b. OEWS wage level:

Hour

Week

Bi-Weekly

Month

Year

I

II

III

IV

OEWS mean

N/A

c. Prevailing wage source (Choose only one):

d. If “Survey” in question 5c, specify the name of the survey:

OEWS (All Industries)

OEWS (ACWIA)

CBA

DBA

SCA

Alternative survey

Professional sports league rules or regulations

6. The wage is based on the following BLS area (Metropolitan or Non-Metropolitan Statistical Area):

7. The highest PWD out of all H-2B worksites for which a prevailing wage determination was requested: $ . per hour.

8. Additional notes regarding wage determination:

9. Determination date:

10. Expiration date:

8. For public burden statement information, please see the Form ETA-9141 General Instructions.

Form ETA-9141

FOR DEPARTMENT OF LABOR USE ONLY

Page 3 of 556

PWD Case Number: Case Status: Validity Period: to