Georgia Department of Labor PREVAILING WAGE REQUEST FORM Please Return To: WI&A - PW Unit Suite 300, Courtland Building 148 Andrew Young International Blvd., N. E. Atlanta, GA 30303-1751 Telephone: (404) 232-3875 Ext. 21262 FAX: (404) 232-3885 Email: GeorgiaPrevailingWage@dol.state.ga.us Please Check One: H-1B Professionals H-2B Temporary ( * * YOUR EMAIL YOUR FAX # * Mandatory) Permanent H-1B1 E-3 MAIL; (Only if no FAX available) (This information cannot be provided by telephone) This prevailing wage determination may be used for more than one application, as long as all job related details and the area of intended employment remain the same. 1. Name of Requestor Address Date Telephone No. 2. 3. Name of Employer (MANDATORY) a.Address Where Alien Will Work (City, County and ZIP) (MANDATORY) Telephone No. Under 20 CFR Part 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. b.Alien's Name (One applicant per request) 4. Nature of Employer's Business 5. Title of Job Being Filled 6. Basic Hours Per Week 7. $ 8. Basic Rate of Pay Offered Per Describe fully the Job Duties to be Performed (Start with the Most Important Duty). You may suggest an SOC code. You must begin Job Description in this block. Use attachment ONLY if necessary. 9. Working Conditions that Affect the Rate of Pay (Including how many workers alien will supervise) 10. State in detail the minimum requirements, not the Alien's qualifications. Any alternative requirements must be filed on a separate request. Education (Degree/Major Field of Study): Training: Experience (MUST STATE EXACT NUMBER OF YEARS AND/OR MONTHS): Any other special requirements: 11. Check if employer's wage is based on a collective bargaining agreement. If checked, state name, number, address and telephone number of Union Local. DEPARTMENTAL ACTION TO PROVIDE A PREVAILING WAGE DETERMINATION Request Number SOC Title The prevailing wage for the job described above is Employers must pay 100% or more of all wage determinations. Source: Agency Official Collective Bargaining Agreement Service Contract Act Completion Date OES Employer Provided survey: Approved Not Approved per SOC Code Skill Level SVP: Prevailing Wage Expires DOL-1687 (R-6/08) American LegalNet, Inc. www.FormsWorkflow.com ITEMIZED INSTRUCTION FOR COMPLETING PREVAILING WAGE REQUEST FORM (To be completed by Employer or Employer Representative) If the job is unionized and covered by a negotiated wage, use the negotiated wage and do not complete this Prevailing Wage Request Form. PLEASE CHECK WHICH OF THE RESPONSE METHODS YOU DESIRE. PLEASE CHECK THE TYPE OF WORK VISA IN THE UPPER RIGHT CORNER. Item 1. Name of Requestor. Enter the name of the person (employer or employer representative) requesting the prevailing wage determination. Include the requestor's name, date of the request, complete mailing address, telephone number, and FAX number. Item 2. a. Name of Employer. For worksite employer, enter full name of business, firm, organization, or if an individual, enter name used on legal documents. THIS IS MANDATORY. b. Telephone Number. Item 3. a. Address Where Alien Will Work. The work place address should include city, county and ZIP code. b. In order to expedite the timeliness of the prevailing wage, please supply the Federal Employer Identification Number (FEIN) of the employer. c. Alien's Name. Enter full name with family name in capital letters and given name in small letters. Only one applicant per request. Item 4. Nature of Employer's Business Activity. Enter Standard Industrial Classification (SIC) Code or a brief nontechnical description, i.e., retail trade, software industry, biotechnology, university, financial institution, hospital, or community service organization, including for profit or non-profit status. Item 5. Title of Job Being Filled. Enter the common name or payroll title of the job being offered. Item 6. Basic Hours Per Week. Show the usual hours of work required on a weekly basis so that a standard work week can be established for the job. Item 7. Basic Rate of Pay Offered. Please enter a basic rate of pay, such as $15.00 per hour, $2,500 per month, or $37,500 per year. The wage offered cannot be based on overtime, commission, bonuses, or other incentives unless the employer guarantees a minimum wage paid on a weekly, biweekly, or monthly basis. Only the minimum amount guaranteed to the employee can be reported. Item 8. Describe Fully the Job Duties to be Performed. Analyze the duties and responsibilities in terms of actions to be performed and the objects of those actions. You may want to consult the O*NET Classification System or the Standard Occupational Classification System to assist in the development of a job description that can easily be categorized by a Prevailing Wage Analyst. In order to standardize the way employers describe jobs on the Prevailing Wage Request Form, the following additional guidelines are suggested: a. Where there are several duties, start with the most important one first. Please differentiate between major and minor duties. For example, Tests and analyzes chemical properties of raw materials or manufactured products for conformance to plant standards; conducts controlled experiments for the purpose of devising new production methods..." b. c. Identify the tools, equipment, and machines the worker in the job uses. Indicate the skill level (complexity) and degree of supervision required to perform the job duties and responsibilities.For example, ..." performs a variety or routine tasks designed to provide experience in methods and procedures...receives specific and detailed instructions with work closely monitored..." (entry level); "performs work with clear and specified objectives requiring selection of standard techniques and established procedures...work is reviewed closely to ensure accuracy and d. conformance with required procedures..." (junior level); "...independently performs a broad range of moderately complex assignments using standard methods or procedures... work is reviewed for application of sound judgment..." (intermediate or journey level); "...solves a variety of complex problems requiring judgment in the selection and modification of standard techniques and procedures... assignments are given with instruct