1 9089 9089form

User Manual: 9089

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Application for Permanent Employment Cer cation
ETA Form 9089
ETA Form 9089 ____________ ___to_______ _________ Page 1 of
U.S. Department of Labor
OMB Approval: 1205-0451
Expiration Date: 11/30/2017
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)?
n
B. Schedule A or Sheepherder Information
1. Is this application in support of a Schedule A or Sheepherder Occupation?
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 ce)
1. Employer’s name
2. Address 1
Address 2
3. City State/Province Country Postal code
4. Phone number Extension
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?
agent or attorney information listed in Section E).
1. Contact’s last name First name Middle initial
2. Address 1
Address 2
3. City State/Province Country Postal code
4. Phone number Extension
5. E-mail address
Yes No
Yes No
Yes No
5. Number of employees 6. Year commenced business
7. FEIN( Federal Employer I r) 8. NAICS Code
ETA Case Number:
Application for Permanent Employment Cer cation
ETA Form 9089
OMB Approval: 1205-0451
Expiration Date: 11/30/2017
ETA Form 9089 ____________ ___to_______ _________ Page 2 of
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)
6. Prevailing wage source (Choose only one)
6-A. If Other is indicated in question 6, specify:
7. Determination date 8. Expiration date
From: To: (Optional) Per: (Choose only one)
$ $
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:
4-A. If Other is indicated in question 4, specify the education required:
5. Is training required for the job opportunity? 5-A. If Yes, number of months of training required:
Hour Month
Week Year
Bi-Weekly
None High School Associate’s Bachelor’s Master’s Doctorate Other
$
Hour Month
Week Year
Bi-Weekly
SCA
DBA
OES CBA Employer Conducted Survey Other
No
Yes
ETA Case Number:
Application for Permanent Employment Certification
ETA Form 9089
OMB Approval: 1205-0451
Expiration Date: 11/30/2017
ETA Form 9089 This Certification is valid from ____________ ___to_______ _________ Page 3 of
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? 6-A. If Yes, number of months experience required:
7. Is there an alternate field of study that is acceptable?
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:
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? 10-A. If Yes, number of months experience in alternate
occupation required:
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?
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.
No Yes
Yes No
Yes No
Yes No
Yes No
Yes No
None High School Associate’s Bachelor’s Master’s Doctorate Other
No Yes
ETA Case Number:
Application for Permanent Employment Certication
ETA Form 9089
ETA Form 9089 This Certication is valid from ____________ ___to_______ _________ Page 4 of
U.S. Department of Labor
OMB Approval: 1205-0451
Expiration Date: 11/30/2017
H. Job Opportunity Information Continued
15. Does this application involve a job opportunity that includes a combination of
occupations?
16. Is the position identied in this application being oered to the alien identied
in Section J?
17. Does the job require the alien to live on the employer’s premises?
18. Is the application for a live-in household domestic service worker?
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?
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?
9. Name of newspaper (of general circulation) in which therst advertisement was placed:
10. Date of rst advertisement identied in question 9:
11. Name of newspaper or professional journal (if applicable) in which second advertisement was placed:
Yes No
No
Newspaper Journal
Yes No
Yes
Yes No
Yes No
Yes No
No
Yes No
Yes No
Yes
Yes No NA
ETA Case Number:
Application for Permanent Employment Cer cation
ETA Form 9089
OMB Approval: 1205-0451
Expiration Date: 11/30/2017
ETA Form 9089 ____________ ___to_______ _________ Page 5 of
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: From: To:
21. Dates advertised with local or ethnic newspaper 22. Dates advertised with radio or TV ads
From: To: 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?
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 preceding the is application?
rkers no and considered for the job
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:
Yes No
Yes No
Yes No
NA
NA
Yes No
Yes No NA
None High School Associate’s Bachelor’s Master’s Doctorate Other
ETA Case Number:
Application for Permanent Employment Certification
ETA Form 9089
ETA Form 9089 This Certification is valid from ____________ ___to_______ _________ Page 6 of
U.S. Department of Labor
OMB Approval: 1205-0451
Expiration Date: 11/30/2017
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 Postal code
17. Did the alien complete the training required for the requested job opportunity,
as indicated in question H.5?
18. Does the alien have the experience as required for the requested job
opportunity indicated in question H.6?
19. Does the alien possess the alternate combination of education and experience
as indicated in question H.8?
20. Does the alien have the experience in an alternate occupation specified in
question H.10?
21. Did the alien gain any of the qualifying experience with the employer in a
position substantially comparable to the job opportunity requested?
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?
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 Country Postal code
4. Type of business 5. Job title
6. Start date 7. End date 8. Number of hours worked per week
Job 1 continued on next page
Yes No
Yes No
Yes No
NA
Yes No NA
Yes No NA
Yes No NA
Yes No NA
ETA Case Number:
Application for Permanent Employment Certi cation
ETA Form 9089
OMB Approval: 1205-0451
Expiration Date: 11/30/2017
ETA Form 9089 This on is valid from ____________ ___to_______ _________ Page 7 of
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 Country Postal code
4. Type of business 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 Country Postal code
4. Type of business 5. Job title
6. Start date 7. End date 8. Number of hours worked per week
Job 3 continued on next page
ETA Case Number:
Application for Permanent Employment Certification
ETA Form 9089
OMB Approval: 1205-0451
Expiration Date: 11/30/2017
ETA Form 9089 This Certification is valid from ____________ ___to_______ _________ Page 8 of
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 Full middle name
2. 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.
M. Declaration of Preparer
1. Was the application completed by the employer?
If No, you must complete this section.
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.
Yes No
ETA Case Number:
Application for Permanent Employment Certification
ETA Form 9089
OMB Approval: 1205-0451
Expiration Date: 11/30/2017
ETA Form 9089 This Certification is valid from ____________ ___to_______ _________ Page 9 of
U.S. Department of Labor
N. Employer Declaration
By virtue of my signature below, I HEREBY CERTIFY the following conditions of employment:
1. The offered wage equals or exceeds the prevailing wage and I will pay at least the prevailing wage.
2. 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 Case Number:
Application for Permanent Employment Cer cation
ETA Form 9089
OMB Approval: 1205-0451
Expiration Date: 11/30/2017
ETA Form 9089 ____________ ___to_______ _________ Page 10 of
U.S. Department of Labor
P. OMB Information 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 Case Number:
Addendum
H. 11. Job duties
ETA Form 9089
Page
of
This Certification is valid from ________________ to ________________
ETA Case Number:
Addendum
H. 14. Specific skills or other requirements
ETA Form 9089
Page
of
This Certification is valid from ________________ to ________________
ETA Case Number:
Addendum
I. 5. Specify additional recruitment information in this space
ETA Form 9089
PagePage
of
This Certification is valid from ________________ to ________________
ETA Case Number:
Addendum
K. 9. Job Details
Page
of
This Certification is valid from ________________ to ________________
ETA Form 9089
ETA Case Number:
1. Employer
2. Address 1
Address 2
3. City State/Province Country Postal code
4. Type of business 5. Job title
6. Start date 7. End dat
e 8.
Numbe r of hou s wor ked per week
9.
Include the phone number of the employer and the name of the alien’s supervisor.)
1. Employer
2. Address 1
Address 2
3. City edoc latsoP yrtnuoC ecnivorP/etatS
4. Type of business 5. Job title
6. Start date 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 supervisor.)
Page
of
Addendum
K. Alien Work Experience Continued
This Certification is valid from ________________ to ________________
ETA Form 9089
name
r
name
ETA Case Number:

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