ESA-1161A FORFF (2-09) ARIZONA DEPARTMENT OF ECONOMIC SECURITY Employment Administration / Foreign Labor Certification PO Box 6123, Site Code 730A Phoenix, AZ 85005 Phone (602) 542-3957 – Fax (602) 542-5022 PREVAILING WAGE REQUEST H-2A, B H-1B Labor Condition Application Labor Certification 1. EMPLOYER NAME 2. PHONE NO. (Include Area Code) 3. EMPLOYER ADDRESS (No., Street, City, State, ZIP) 4. ALIEN’S NAME (Last, First, M.I.) 5. ADDRESS OF WHERE ALIEN WILL WORK (If different from Employer Address) 6. NATURE OF EMPLOYER’S BUSINESS ACTIVITY OR INDUSTRY 8. STANDARD OCCUPATIONAL CLASSIFICATION (SOC) 9. HOURS OR WORK PER WEEK 11. RATE OF PAY $ 7. JOB TITLE 12. STATE LICENSE REQUIRED Per Yes 10. WORK HOURS 13. NO. OF EMPLOYEES SUPERVISED No 14. UNIONIZED Yes No 15. DESCRIBE FULLY THE JOB DUTIES TO BE PERFORMED 16. COLLEGE DEGREE REQUIRED (Specify) 17. MAJOR FIELD OF STUDY 18. MINIMUM EXPERIENCE REQUIRED 19. SKILL LEVEL 20. OTHER SPECIAL REQUIREMENTS 21. REQUESTOR’S NAME 22. ADDRESS WHERE INFORMATION IS TO BE SENT (If different than address above) 23. REQUESTOR’S PHONE NO. (Include area code) 24. REQUESTOR’S FAX NO. (Include area code) FOR DES / FLC USE ONLY 25. SWA CASE NO. Fax completed form to (602) 542-5022 or e-mail to +E&TSpecProg@azdes.gov Equal Opportunity Employer/Program Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, and the Age Discrimination Act of 1975, the Department prohibits discrimination in admissions, programs, services, activities, or employment based on race, color, religion, sex, national origin, age, and disability. The Department must make a reasonable accommodation to allow a person with a disability to take part in a program, service or activity. For example, this means if necessary, the Department must provide sign language interpreters for people who are deaf, a wheelchair accessible location, or enlarged print materials. It also means that the Department will take any other reasonable action that allows you to take part in and understand a program or activity, including making reasonable changes to an activity. If you believe that you will not be able to understand or take part in a program or activity because of your disability, please let us know of your disability needs in advance if at all possible. To request this document in alternative format or for further information about this policy, contact 602-252-2652; TTY/TDD Services: 7-1-1. American LegalNet, Inc. www.FormsWorkflow.com Itemized Instructions for Completing Prevailing Wage Request TO BE COMPLETED BY EMPLOYER OR EMPLOYER REPRESENTATIVE 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. Please identify the type of application/attestation in the heading of the first page. Employer Name - Enter full name of business, firm, organization, or if an individual, enter name used for legal purposes on documents. Phone No. - Enter complete number of employer including area code. Employer Address - Enter the address of the home office of the company. Alien’s Name - Enter the complete name for which the application/attestation will be filed. Address of Where Alien Will Work - This is to be completed if different than the company home office address. Nature of Employer's Business Activity or Industry - Enter North American Industry Classification Code or a brief nontechnical description, i.e. retail trade, software industry, biotechnology, university, financial institution, hospital, city, state or federal government, and community service organization, including for profit and non-profit status. Job Title - Enter the common name or payroll title of the job being offered. Standard Occupational Classification (SOC) - Enter the SOC seven-digit codes in the format 99-9999. Hours or Work Per Week - Enter the basic number of work hours required on a weekly basis so that the standard work week can be established for the job. Work Hours - Enter the daily hours, start and ending time, the employee is expected to work. Rate of Pay - Enter a guaranteed basic rate of pay and the unit of pay, such as $15.00 per hour, $2,500 per month or $37,500 per year. The wage offered cannot be based on commission, bonuses, or other incentives, unless the employer guarantees a wage paid on a weekly, biweekly, or monthly basis. Only the minimum amount guaranteed to the employee can be reported. State License Required - Enter the type of license required. If none if required indicate "None" or "N/A". No. of Employees Supervised - Enter the number of employees supervised. If no employees are to be supervised, enter "None" or "N/A". Unionized - Check "yes" or "no" as applicable. Describe Fully the Job Duties to be Performed - Describe the duties of the job by starting with the most important one first. In describing what the worker does, care must be given to use the appropriate action verbs. These are necessary for the Wage Analyst to define a skill level within the job's occupational category, if appropriate. Equipment used, working conditions, degree of supervision, or supervisory responsibilities are just some of the job factors considered in defining the job's occupational category and, eventually, the prevailing wage rate for the labor market area. The complexity of the job duties required should be reflected in the action verbs and objects of these verbs. College Degree Required - Enter the type of college degree required such as, AA, BS, BA, MS, MSEE, Ph.D., etc. Major Field of Study - Specify the major field of study, i.e. Computer Science, Aerospace Engineering, Education, Speech and Hearing Science, Marketing, etc. Minimum Experience Required - State in detail the minimum experience requirements for any worker to perform satisfactorily the job duties described in Item 14. Skill Level - Enter the Skill Level if known. Other Special Requirements - Identify any special requirements related to the job duties. Examples: read, write, speak a foreign language, must be eligible for State Civil Engineer license, 3 months experience using WordStar program, etc. Requestor’s Name - Enter the employer or employer representative requesting the prevailing wage determination. Address Where Information is to be Sent - Enter complete mailing address (if different than address on Item 3). Requestor’s Phone No. - Enter requestor’s phone number. Requestor’s Fax No. - Enter requestor’s fax number. For DES / FLC Only 25. SWA Case No. - To be filled out by the State Workforce Agency only. In Arizona, this is the DES Foreign Labor Certification Unit, Prevailing Wage Unit. Prevailing Wage Determination Requests and Forms For prevailing wage determination information and forms for H-1B LCAs (including the ETA 9035 forms), contact: Arizona Department of Economic Security Foreign Labor Certification Unit P.O. Box 6123, Site Code 730A Phoenix, AZ 85005-6123 Phone: (602) 542-3957 Fax: (602) 542-5022 The actual prevailing wage determination request must be in writing, and can be mailed or faxed. American LegalNet, Inc. www.FormsWorkflow.com