DC Department of Employment Services PREVAILING WAGE SURVEY UNIT 64 New York Avenue, NE • Room 3056 Washington, DC 20002 (202) 671-1643 (voice) • (202) 673-3796 (fax) PREVAILING WAGE REQUEST FORM Determination for: Labor Certification Application _________________ Labor Condition Application ____________________ EMPLOYER INFORMATION Name of Firm: ____________________________________________________________________________ Address: _________________________________________________________________________________ City: ________________________________ State: _______________________ Zip code: _____________ Contact Person: ________________________________________ Phone No.: ________________________ Job Location: _____________________________________________________________________________ No. of Employees: ___________________________________ Annual Gross Income: $_________________ APPLICANT INFORMATION Name of Alien: ____________________________________________________________________________ Employee Job Title: _______________________________________________________________________ D.O.T. Code:/O’Net Code: __________________________________________________________________ D.O.T. Title: ______________________________________________________________________________ Duties: ___________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ If necessary include attachments JOB REQUIREMENTS HOURS OF WORK PER WEEK: ______ YR(s) OF EXPERIENCE REQUIRED: ______ yr./_____ mo. EDUCATION: ________________________________________________________________________________ NUMBER OF EMPLOYEES ALIEN WILL SUPERVISE: ___________________________________________ TITLE OF ALIEN’S IMMEDIATE SUPERVISOR: _________________________________________________ [FOR OFFICIAL USE ONLY] Valid thru: ______________ $ _________________________________ Per ___________________________ Source: ____________________________________________________________________________ Date: _________________ By: ___________________________________________________________________________________ Date: ______________ Wage and Salary Specialist American LegalNet, Inc. www.FormsWorkflow.com