MISSOURI PREVAILING WAGE REQUEST FORM Please complete this form and mail or fax to ATTN: Name: Holly Harber, Research Manager Missouri Department of Economic Development Missouri Economic Research & Information Center (MERIC) 301 West High Street, Room 720 PO Box 3150 Jefferson City, MO 65102-3150 Phone: 573-751-3624 Fax: 573-751-9815 E-mail: holly.harber@ded.mo.gov Street Address: City, State, Zip: Telephone No: Fax No: Part A. Offer of Employment 1. Name of Alien (Family name in capital letters. First, Middle, Maiden) 2. Present Address of Alien (Number, Street, City and Town, State ZIP Code or 3. Type of VISA (If in U.S.) Province, Country) The following information is submitted as evidence of an offer of employment 4. Name of Employer (Full name of organization) 5. __ __ __ - __ __ __ - __ __ __ __ 6. Address (Number, Street, City or Town, Country, State, ZIP Code) 7. Address Where Alien Will Work (If different from item 6) 8. Nature of Employers Business 9. Name of Job Title Activity 10. Total Hours Per Week 11. Work a. Basic b. Overtime Schedule (Hrly) a.m. p.m. 12. Rate of Pay a. Basic b. Overtime 13. Describe Fully the Job to be Performed (duties) 14. State in detail the MINIMUM education, training, and experience for a worker to perform satisfactorily the job duties described in Item 13 above EDUCATION Grade High College College Degree Required (specify) 15. Other Special Requirements (Enter number of years) School School TRAINING No. Yrs. No. Mos. Type of Training EXPERIENCE Job Offered Related Occupation Related Occupation (specify) Yrs. Yrs. Major Field of Study Mos. Mos. 16. Occupational Title of Person who will be Alien's Immediate Supervisor Remarks: 17. Number of Employees Alien will Supervise