REQUEST FOR PREVAILING WAGE State Form 48364 (R3 / 6-08) INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT F OR E IG N L A B OR C E R T IF IC A T ION UNIT 10 N. S E NA T E A V E NUE , INDIA NA P OL IS , INDIA NA 46204-2277 P HONE : (317) 233-6681 F A X: (317) 234-2932 P L E A S E NOT E : T his information provided here is for the purpos es of determining the P R E V A IL ING WA G E for the oc c upation lis ted. T his wage is required for c ertain immigration-related ac tivities . It is not valid for any other purpos e. A ll reques ted information mus t be provided or the reques t will be returned via U.S .P .S mail to obtain the mis s ing information. DWD-F L C T rac king Number: 1. Name and addres s of pers on reques ting determination: 2. F A X No.: 4. Name of E mployer: 5. F ederal E mployer ID Number: 6. C ity and C ounty propos ed employment 7. If employer is a post-secondary institution, indicate discipline or school 8. Nature of Employer's business: 9. Job Title: ( ) 3. T elephone No.: ( ) C ity 10. Complete job description ( use additional sheet if necessary ): 11. C ounty State in Detail the MINIMUM requirements for above position College Degree required (specify) Major Field of Study TRAINING: Number of Years Number of Months EDUCATION: (enter number of years) Type of Training High School E XP E R IE NC E : J ob Offered College Technical/Trade R elated Oc c upation Y ears Month 12. Job T i t l e Oc c upational title of worker's immediate s upervis or 14. Months S pec ial requirements if any: 13. Years Number of employees worker will supervis e DO NOT MA K E A NY E NT R IE S B E L OW T he prevailing wage for the above oc c upation in the area indic ated has been determined to be $ OE S /O-Net C ode Date of Determination: p er Level: T HIS DE T E R MINA T ION IS V A L ID F OR NOT L E S S T HA N 90 DA Y S OR MOR E T HA N_______ F R OM T HE DA T E OF IS S UE (determination). American LegalNet, Inc. www.FormsWorkflow.com