Department of Employment and Economic Development Foreign Labor Certification 651.259.7506 Check One H-1B H-2B PERM State of Minnesota PREVAILING WAGE REQUEST FAX: 651.297.7722 1. Employer/Business Name (Full Legal Name) 2. Employer/Business Address (City, State) 3. Job Site (City, State) 4. Job Site County 5. Nature of Employer's Business 6. Job Title of Available Position 7. Number and Type of Workers Position will Supervise (If none, write "None.") 8. Title of Position's Immediate Supervisor 9. Wage Subject to a Collective Bargaining Agreement? YES (Attach evidence of contract period and 10. Institution of Higher Education or Related or Affiliated Non-profit Entity Non-profit Research Organization (Attach IRS Tax negotiated wage rate.) NO Exemption Evidence) 11. JOB DESCRIPTION. Fully describe the work to be performed (major duties and tasks). List specific tools, equipment, technologies, etc., required to do the job; indicate how much supervision the position receives and how much independence in judgment/decision-making the position allows. 12. College Degree Required? YES (Specify type of degree and major field of study) 13. Formal Training Required? YES (Specify Technical, Vocational or Apprenticeship Program, length of program, and field of study) NO NO 14. Least Amount of Experience Needed to Perform Job (If none, enter "0.") 15. License or Certification Required? YES (List specific license and/or certification) Number of Months: NO Date of Request 16. Other Requirements Needed for Job? YES (Specify special skills or proficiencies) NO Name of Requestor/Title Name of Requestor’s Organization Requestor’s Business Address Phone Number Fax Number PREVAILING WAGE DETERMINATION (State Workforce Agency Use Only) O*NET Occupational Code O*NET Occupational Title Prevailing Wage Survey Source $ per hour $ Issue Date per year Expiration Date of Determination OES All Industries Skill Level OES Education Survey Year Other Prevailing Wage Analyst NOTE: If the information provided will be used to complete the Application for Permanent Employment Certification, Form ETA 9089, the employer is required to retain this document for a period of five (5) years from the date of filing. Rev. 06/05 American LegalNet, Inc. www.FormsWorkflow.com