New Jersey Department of Labor and Workforce Development Alien Labor Certification PO Box 053 – Trenton, NJ 08625-0053 Telephone: 609-292-2900 Fax: 609-777-3570 1. Full Legal Name of Employer 2. Federal Employer ID Number (9 digits - optional) 3. Application Type H2B PERM H-1B 5. Type of Business Activity 4. Address (Number, Street, City/Town, State & ZIP code) 6. Contact Person Name 7. Telephone Number ) ( 8. Fax Number ) ( 10. Job Title of Position Offered 11. Hours per week worked 14. Occupational Title of Alien’s Immediate Supervisor 15. # & Title of workers alien will supervise 9. E-mail 12. Work Location (City/Town & State) 13. County of Work Location 16. Is wage subject to union contract? Yes No 17. Job Description (suggested SOC/O*NET Code - optional) 18. Education & Training Level (min diploma, degree or training required) 19. Training Required? Yes No If yes, state type and years/months. 21. Experience Required? Yes No If yes, state number of years/months. 22. Other Special Skills or Requirements Name of person requesting prevailing wage 20. College Degree Required? Yes If yes, specify type and major of study 23. License Required? If yes, state type. Yes No No Signature of person Title Telephone number FAX number ( ( ) ) NOTE: The information provided is to be used to complete the Application for Permanent Employment Certification, Form ETA9089, as appropriate. The employer is not required to submit this form with the application but is required to retain this document for a period of 5 years from the date of filing. This prevailing wage is valid until ____________________ PREVAILING WAGE DETERMINATION (for SWA use only) Occupational Code Prevailing Wage $ SWA Analyst Occupational title Per Hour Year Skill Level Survey Source Survey Area OES SCA DBA Determination Date Please indicate mailing name and address: CBA Other ______________ Tracking Number Mail form to: NJ Department of LWD Alien Labor Certification PO Box 053 Trenton, NJ 08625-0053 - or - Fax to: 609-777-3570 NJLWD-ALC-1 (5/09) American LegalNet, Inc. www.FormsWorkFlow.com