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User Manual: 9089
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OMB Approval: 1205-0451 Expiration Date: 11/30/2017 Application for Permanent Employment Cer cation ETA Form 9089 U.S. Department of Labor ing this form. A copy of the instructions can be found at http://www.foreignlaborcert.doleta.gov/pdf/9089inst.pdf Employing or continuing to employ an alien unauthorized to work in the United States is illegal and may subject the employer to criminal prosecution, civil money penalties or both. A. ling Instructions 1. Are you seeking to utilize the ing date from a previously submitted Application for Alien Emplo on (ETA 750)? Yes No n B. Schedule A or Sheepherder Information 1. Is this application in support of a Schedule A or Sheepherder Occupation? Yes If Yes, do NOT send this application to the Department of Labor. All applications in support of Schedule A or Sheepherder Occupations must C. Employer Information (Headquarters or Ma No ce) 1. Employer’s name 2. Address 1 Address 2 3. City State/Province 4. Phone number Postal code Extension 5. Number of employees 7. FEIN( Federal Employer I Country 6. Year commenced business r) 8. NAICS Code 9. Is the employer a closely held corporation, partnership, or sole proprietorship in which the alien has an ownership interest, or is there a familial relationship between the owners, stockholders, corpo cers, incorporators, or partners, and the alien? No Yes agent or attorney information listed in Section E). 1. Contact’s last name First name Middle initial 2. Address 1 Address 2 3. City 4. Phone number State/Province Country Postal code Extension 5. E-mail address ETA Form 9089 ETA Case Number: ____________ ___to_______ _________ Page 1 of OMB Approval: 1205-0451 Expiration Date: 11/30/2017 Application for Permanent Employment Cer cation ETA Form 9089 U.S. Department of Labor E. Agent or Attorney Information (If applicable) 1. Agent or attorney’s last name First name Middle initial 2. Firm name 3. Firm EIN 4. Phone number Extension 5. Address 1 Address 2 6. City State/Province Country Postal code 7. E-mail address F. Prevailing Wage Information (as provided by the State Workforce Agency) 1. Prevailing wage tracking number (if applicable) 2. SOC/O*NET(OES) code 3. Occupation Title 4. Skill Level 5. Prevailing wage Per: (Choose only one) $ Week Hour 6. Prevailing wage source (Choose only one) OES CBA Employer Conducted Survey Bi-Weekly Month DBA SCA Bi-Weekly Month Year Other 6-A. If Other is indicated in question 6, specify: 7. Determination date From: $ To: (Optional) $ 8. Expiration date Per: (Choose only one) Hour Week Year H. Job Opportunity Information (Where work will be performed) 1. Primary worksite (where work is to be performed) address 1 Address 2 2. City State Postal code 3. Job title 4. Education: minimum level required: None High School Associate’s Bachelor’s Master’s Doctorate Other 4-A. If Other is indicated in question 4, specify the education required: 5. Is training required for the job opportunity? No Yes ETA Form 9089 ETA Case Number: 5-A. If Yes, number of months of training required: ____________ ___to_______ _________ Page 2 of OMB Approval: 1205-0451 Expiration Date: 11/30/2017 Application for Permanent Employment Certification ETA Form 9089 U.S. Department of Labor H. Job Opportunity Information Continued 5-B. Indicate the field of training: 6. Is experience in the job offered required for the job? Yes 6-A. If Yes, number of months experience required: No 7. Is there an alternate field of study that is acceptable? Yes No Yes No 7-A. If Yes, specify the major field of study: 8. Is there an alternate combination of education and experience that is acceptable? 8-A. If Yes, specify the alternate level of education required: None High School Associate’s Bachelor’s Master’s Doctorate Other 8-B. If Other is indicated in question 8-A, indicate the alternate level of education required: 8-C. If applicable, indicate the number of years experience acceptable in question 8: 9. Is a foreign educational equivalent acceptable? 10. Is experience in an alternate occupation acceptable? Yes Yes No 10-A. If Yes, number of months experience in alternate occupation required: No 10-B. Identify the job title of the acceptable alternate occupation: 11. Job duties – If submitting by mail, add attachment if necessary. Job duties description must begin in this space. 12. Are the job opportunity’s requirements normal for the occupation? If the answer to this question is No, the employer must be prepared to provide documentation demonstrating that the job requirements are supported by business necessity. 13. Is knowledge of a foreign language required to perform the job duties? Yes No Yes No If the answer to this question is Yes, the employer must be prepared to provide documentation demonstrating that the language requirements are supported by business necessity. 14. Specific skills or other requirements – If submitting by mail, add attachment if necessary. Skills description must begin in this space. ETA Form 9089 ETA Case Number: This Certification is valid from ____________ ___to_______ _________ Page 3 of OMB Approval: 1205-0451 Expiration Date: 11/30/2017 Application for Permanent Employment Certification ETA Form 9089 U.S. Department of Labor H. Job Opportunity Information Continued 15. Does this application involve a job opportunity that includes a combination of occupations? Yes No 16. Is the position identified in this application being offered to the alien identified in Section J? Yes No Yes No 18. Is the application for a live-in household domestic service worker? Yes No 18-A. If Yes, have the employer and the alien executed the required employment contract and has the employer provided a copy of the contract to the alien? Yes No Yes No Yes No Yes No Yes No 17. Does the job require the alien to live on the employer’s premises? NA I. Recruitment Information a. Occupation Type – All must complete this section. 1. Is this application for a professional occupation, other than a college or university teacher? Professional occupations are those for which a bachelor’s degree (or equivalent) is normally required. 2. Is this application for a college or university teacher? If Yes, complete questions 2-A and 2-B below. 2-A. Did you select the candidate using a competitive recruitment and selection process? 2-B. Did you use the basic recruitment process for professional occupations? b. Special Recruitment and Documentation Procedures for College and University Teachers – Complete only if the answer to question I.a.2-A is Yes. 3. Date alien selected: 4. Name and date of national professional journal in which advertisement was placed: 5. Specify additional recruitment information in this space. Add an attachment if necessary. c. Professional/Non-Professional Information – Complete this section unless your answer to question B.1 or I.a.2-A is YES. 6. Start date for the SWA job order 7. End date for the SWA job order 8. Is there a Sunday edition of the newspaper in the area of intended employment? Yes No 9. Name of newspaper (of general circulation) in which the first advertisement was placed: 10. Date of first advertisement identified in question 9: 11. Name of newspaper or professional journal (if applicable) in which second advertisement was placed: Newspaper ETA Form 9089 ETA Case Number: This Certification is valid from ____________ ___to_______ _________ Journal Page 4 of OMB Approval: 1205-0451 Expiration Date: 11/30/2017 Application for Permanent Employment Cer cation ETA Form 9089 U.S. Department of Labor I. Recruitment Information Continued 12. Date of second newspaper advertisement or date of publication of journal iden ed in question 11: d. Professional Recruitment Information – Complete if the answer to question I.a.1 is YES or if the answer to I.a.2-B is YES. Complete at least 3 of the items. 13. Dates advertised at job fair 14. Dates of on-campus recruiting From: To: From: To: 15. Dates posted on employer web site 16. Dates advertised with trade or professional organization From: To: From: T o: 17. Dates listed with job search web site 18. Dates listed with private empl From: To: From: To: From: To: 21. Dates advertised with local or ethnic newspaper From: To: From: To: 22. Dates advertised with radio or TV ads From: To: e. General Information – All must complete this section. 23. Has the employer received payment of any kind for this submission of this application? Yes No 23-A. If Yes, describe details of the payment including the amount, date and purpose of the payment : 24. Has the bargaining representative for workers in the occupation in which the alien will be employed been provided with notice ing at least 30 days but not more than 180 days before the date the application is 25. If there is no bargaining representative, has a notice of ng been posted for 10 business days in a conspicuous location at the place of employment, ending at least 30 days before but not more than 180 days before the date the application led? 26. Has the employer had a layo in the area of intended employment in the occupation involved in this application or in a related occupation within the six months immediately preced ing the is application? rkers no and considered for the job Yes No NA Yes No NA Yes No Yes No NA or attorney information listed in Section E). 1. Alien’s last name First name Full middle name 2. Current address 1 Address 2 3. City State/Province Country Postal code 4. Phone number of current residence 5. Country of citizenship 6. Country of birth 7. Alien’s date of birth 8. Class of admission 9. Alien registration number (A#) 10. Alien admission number (I-94) 11. Education: highest level achieved as required by the requested job opportunity: None ETA Form 9089 ETA Case Number: High School Associate’s Bachelor’s Master’s ____________ ___to_______ _________ Doctorate Other Page 5 of OMB Approval: 1205-0451 Expiration Date: 11/30/2017 Application for Permanent Employment Certification ETA Form 9089 U.S. Department of Labor J. Alien Information Continued 11-A. If Other indicated in question 11, specify 12. Specify major field(s) of study 13. Year relevant education completed 14. Institution where relevant education specified in question 11 was received 15. Address 1 of conferring institution Address 2 16. City State/Province Country 17. Did the alien complete the training required for the requested job opportunity, as indicated in question H.5? Postal code Yes No NA 18. Does the alien have the experience as required for the requested job opportunity indicated in question H.6? Yes No NA 19. Does the alien possess the alternate combination of education and experience as indicated in question H.8? Yes No NA 20. Does the alien have the experience in an alternate occupation specified in question H.10? Yes No NA 21. Did the alien gain any of the qualifying experience with the employer in a position substantially comparable to the job opportunity requested? Yes No NA 22. Did the employer pay for any of the alien’s education or training necessary to satisfy any of the employer’s job requirements for this position? Yes No Yes No 23. Is the alien currently employed by the petitioning employer? K. Alien Work Experience List all jobs the alien has held during the past 3 years. Also list any other experience that qualifies the alien for the job opportunity for which the employer is seeking certification. a. Job 1 1. Employer name 2. Address 1 Address 2 3. City State/Province 4. Type of business 6. Start date Country Postal code 5. Job title 7. End date 8. Number of hours worked per week Job 1 continued on next page ETA Form 9089 ETA Case Number: This Certification is valid from ____________ ___to_______ _________ Page 6 of OMB Approval: 1205-0451 Expiration Date: 11/30/2017 Application for Permanent Employment Certi cation ETA Form 9089 U.S. Department of Labor K. Alien Work Experience Continued 9. Job details (duties performed, use of tools, machines, equipment, skills, qualifications, certifications, licenses, etc. Include the phone number of the employer and the name of the alien’s supervisor.) b. Job 2 1. Employer name 2. Address 1 Address 2 3. City State/Province 4. Type of business Country Postal code 5. Job title 6. Start date 7. End date 8. Number of hours worked per week 9. Job details (duties performed, use of tools, machines, equipment, skills, qualifications, certifications, licenses, etc. Include the phone number of the employer and the name of the alien’s supervisor.) c. Job 3 1. Employer name 2. Address 1 Address 2 3. City State/Province 4. Type of business Country Postal code 5. Job title 6. Start date 7. End date 8. Number of hours worked per week Job 3 continued on next page ETA Form 9089 ETA Case Number: This on is valid from ____________ ___to_______ _________ Page 7 of OMB Approval: 1205-0451 Expiration Date: 11/30/2017 Application for Permanent Employment Certification ETA Form 9089 U.S. Department of Labor K. Alien Work Experience Continued 9. Job details (duties performed, use of tools, machines, equipment, skills, qualifications, certifications, licenses, etc. Include the phone number of the employer and the name of the alien’s supervisor.) L. Alien Declaration I declare under penalty of perjury that Sections J and K are true and correct. I understand that to knowingly furnish false information in the preparation of this form and any supplement thereto or to aid, abet, or counsel another to do so is a federal offense punishable by a fine or imprisonment up to five years or both under 18 U.S.C. §§ 2 and 1001. Other penalties apply as well to fraud or misuse of ETA immigration documents and to perjury with respect to such documents under 18 U.S.C. §§ 1546 and 1621. In addition, I further declare under penalty of perjury that I intend to accept the position offered in Section H of this application if a labor certification is approved and I am granted a visa or an adjustment of status based on this application. 1. Alien’s last name First name 2. Signature Full middle name Date signed Note – The signature and date signed do not have to be filled out when electronically submitting to the Department of Labor for processing, but must be complete when submitting by mail. If the application is submitted electronically, any resulting certification MUST be signed immediately upon receipt from DOL before it can be submitted to USCIS for final processing. M. Declaration of Preparer 1. Was the application completed by the employer? If No, you must complete this section. Yes No I hereby certify that I have prepared this application at the direct request of the employer listed in Section C and that to the best of my knowledge the information contained herein is true and correct. I understand that to knowingly furnish false information in the preparation of this form and any supplement thereto or to aid, abet, or counsel another to do so is a federal offense punishable by a fine, imprisonment up to five years or both under 18 U.S.C. §§ 2 and 1001. Other penalties apply as well to fraud or misuse of ETA immigration documents and to perjury with respect to such documents under 18 U.S.C. §§ 1546 and 1621. 2. Preparer’s last name First name Middle initial 3. Title 4. E-mail address 5. Signature Date signed Note – The signature and date signed do not have to be filled out when electronically submitting to the Department of Labor for processing, but must be complete when submitting by mail. If the application is submitted electronically, any resulting certification MUST be signed immediately upon receipt from DOL before it can be submitted to USCIS for final processing. ETA Form 9089 ETA Case Number: This Certification is valid from ____________ ___to_______ _________ Page 8 of OMB Approval: 1205-0451 Expiration Date: 11/30/2017 Application for Permanent Employment Certification ETA Form 9089 U.S. Department of Labor N. Employer Declaration By virtue of my signature below, I HEREBY CERTIFY the following conditions of employment: 1. 2. The offered wage equals or exceeds the prevailing wage and I will pay at least the prevailing wage. The wage is not based on commissions, bonuses or other incentives, unless I guarantees a wage paid on a weekly, bi-weekly, or monthly basis that equals or exceeds the prevailing wage. 3. I have enough funds available to pay the wage or salary offered the alien. 4. 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. 5. The job opportunity does not involve unlawful discrimination by race, creed, color, national origin, age, sex, religion, handicap, or citizenship. 6. The job opportunity is not: a. Vacant because the former occupant is on strike or is being locked out in the course of a labor dispute involving a work stoppage; or b. At issue in a labor dispute involving a work stoppage. 7. The job opportunity’s terms, conditions, and occupational environment are not contrary to Federal, state or local law. 8. The job opportunity has been and is clearly open to any U.S. worker. 9. The U.S. workers who applied for the job opportunity were rejected for lawful job-related reasons. 10. The job opportunity is for full-time, permanent employment for an employer other than the alien. I hereby designate the agent or attorney identified in section E (if any) to represent me for the purpose of labor certification and, by virtue of my signature in Block 3 below, I take full responsibility for the accuracy of any representations made by my agent or attorney. I declare under penalty of perjury that I have read and reviewed this application and that to the best of my knowledge the information contained herein is true and accurate. I understand that to knowingly furnish false information in the preparation of this form and any supplement thereto or to aid, abet, or counsel another to do so is a federal offense punishable by a fine or imprisonment up to five years or both under 18 U.S.C. §§ 2 and 1001. Other penalties apply as well to fraud or misuse of ETA immigration documents and to perjury with respect to such documents under 18 U.S.C. §§ 1546 and 1621. 1. Last name First name Middle initial 2. Title 3. Signature Date signed Note – The signature and date signed do not have to be filled out when electronically submitting to the Department of Labor for processing, but must be complete when submitting by mail. If the application is submitted electronically, any resulting certification MUST be signed immediately upon receipt from DOL before it can be submitted to USCIS for final processing. O. U.S. Government Agency Use Only Pursuant to the provisions of Section 212 (a)(5)(A) of the Immigration and Nationality Act, as amended, I hereby certify that there are not sufficient U.S. workers available and the employment of the above will not adversely affect the wages and working conditions of workers in the U.S. similarly employed. This Certification is valid from _____________ to _____________ ______________________________________________ Signature of Certifying Officer Date ___ ___________________________ Signed ______________________________________________ Case Number ___ ___________________________ Filing Date ETA Form 9089 ETA Case Number: This Certification is valid from ____________ ___to_______ _________ Page 9 of OMB Approval: 1205-0451 Expiration Date: 11/30/2017 P. OMB Information Application for Permanent Employment Cer cation ETA Form 9089 U.S. Department of Labor Paperwork Reduction Act Information Control Number 1205-0451 Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Respondent’s collection of information is estimated to average 1¼ hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing Washington, DC * 20210. Do NOT send the completed application to this address. Q. Privacy Statement Information that the information provided herein is protected under the Privacy Act. The Department of Labor (Department or DOL) maintains a System of Records titled Employer Application and Attestation File for Permanent and Temporary Alien Workers (DOL/ETA-7) that includes this record. ed in processing labor applications, their representatives, to named alien be deral courts; and in connection with administering and enforcing immigration laws and regulations, records may be released to such ector General, Employment Standards Administration, the Department of Homeland Security, and the Department of State. Further relevant disclosures may be made in accordance with the Privacy Act and 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 or public matters; to a contractor or their employees, grantees or their employees, consultants, or volunteers who have been engaged to assist the agency in the performance of Federal activities; uest of the subject of the record; in connection with records management; and to the news media and the public when a matter under investigation becomes public knowledge, the Solicitor of Labor determines the of Labor determines that a legitimate public interest exists in the disclosure of information, unless the Solicitor of Labor determines that disclosure would constitute an unwarranted invasion of personal privacy. ETA Form 9089 ETA Case Number: ____________ ___to_______ _________ Page 10 of Addendum H. 11. Job duties ETA Form 9089 ETA Case Number: This Certification is valid from ________________ to ________________ Page of Addendum H. 14. Specific skills or other requirements ETA Form 9089 ETA Case Number: This Certification is valid from ________________ to ________________ Page of Addendum I. 5. Specify additional recruitment information in this space ETA Form 9089 ETA Case Number: This Certification is valid from ________________ to ________________ Page of Addendum K. 9. Job Details ETA Form 9089 ETA Case Number: This Certification is valid from ________________ to ________________ Page of Addendum K. Alien Work Experience Continued 1. Employer name 2. Address 1 Address 2 3. City State/Province Country 4. Type of business 6. Start date Postal code 5. Job title 8. Number of hou rs wor ked per week 7. End date 9. Include the phone number of the employer and the name of the alien’s supervisor.) 1. Employer name 2. Address 1 Address 2 3. City St ate / P rovinc e C ountry 4. Type of business 6. Start date Post al code 5. Job title 7. End date 8. Number of hours worked per week 9. Include the phone number of the employer and the name of the alien’s superv isor.) ETA Form 9089 ETA Case Number: This Certification is valid from ________________ to ________________ Page of
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