ARKANSAS PREVAILING WAGE REQUEST FORM Foreign Labor Certification John Newkirk / Prevailing Wage Specialist P.O. Box 2981 Little Rock, Arkansas 72203 501-683-2372 Fax: 501-683-5915 E-mail request to: john.newkirk@arkansas.gov Date of Request______________ EMPLOYER'S BUSINESS NAME, ADDRESS, FAX & BUSINESS TELEPHONE NUMBERS, NAME AND TITLE OF CONTACT PERSON: NATURE OF EMPLOYER'S BUSINESS JOB TITLE & O*Net Code (if known) # HOURS / WEEK BASIC RATE OF PAY OFFERED DESCRIPTION OF JOB DUTIES and O*NeT Code (if known): CITY & COUNTY WHERE WORK WILL BE PERFORMED MINIMUM EDUCATION REQUIRED (DEGREE & MAJOR FIELD OF STUDY) LICENSE REQUIRED? MINIMUM EXPERIENCE REQUIRED LEVEL OF SUPERVISION REQUIRED FOR THIS POSITION NUMBER OF EMPLOYEES SUPERVISED BY THIS POSITION REQUESTOR'S NAME, ADDRESS, FAX & BUSINESS TELEPHONE NUMBERS, NAME & TITLE OF CONTACT PERSON: The Prevailing Wage for the position is $ Level I _______ ___ per year or $ ___ Level IV _______ per hour. Level II _______ Level III _______ Survey Used: Service Contract Act ___ Davis Bacon Act ___ Union Wage ___ OES ___ ACWIA-Higher Education ___ Other ___ O*Net Code: _____________ O*Net Title: ______________________________________________ Prevailing wage determinations are made in accordance with Federal Regulations and based on the best information available at the time of the request. This information is valid for use in filing applications and attestations for a period of no less than 90 days to no more than one (1) year from the date of this response or until the next release of OES survey data. NOTE: According to USDOL instructions, this Determination may be used for more than one application, if all job related details and the area of intended employment remain the same. NOTE: Under 20 CFR 656.40(i), wage cannot be lower than required by any other law. No prevailing wage determination for labor certification purposes made under this section permits an employer to pay a wage lower than the highest wage required by any applicable Federal, state or local law. American LegalNet, Inc. www.FormsWorkFlow.com Determination Date: ________________ Revised 12/08