OMB Approval: 1205-0466 Expiration Date: 11/30/2011 Application for Temporary Employment Certification ETA Form 9142 U.S. Department of Labor Please read and review the filing instructions carefully before completing the ETA Form 9142. A copy of the instructions can be found at http://www.foreignlaborcert.doleta.gov/. In accordance with Federal Regulations, incomplete or obviously inaccurate applications will not be certified by the Department of Labor. If submitting this form non-electronically, ALL required fields/items containing an asterisk ( * ) must be completed as well as any fields/items where a response is conditional as indicated by the section ( § ) symbol. For conve nie nce and compat ibility for al l scree n rea de rs, the use r will be prompte d for a re quire d quest ion again in eac h fie ld in a ddition to the a sterisk. A. Employment-Based Nonimmigrant Visa Information 1. Indicate the type of visa classification supported by this application (Write classification symbol): * Requ ir ed Field B. Temporary Need Information 1. Job Title * Required F ield 2. SOC (ONET/OES) code * 3. SOC (ONET/OES) occupation title * Requir ed F ield 4. Is this a full-time position? * ‰ Yes Requir ed F ield Period of Intended Employment Requir ed Field 5. Begin Date * ‰ No 6. End Date * Required Field (mm/dd/yyyy) Required Field (mm/dd/yyyy) 7. Worker positions needed/basis for the visa classification supported by this application Total Worker Positions Being Requested for Certification * Requir ed Field Basis for the visa classification supported by this application (indicate the total workers in each applicable category based on the total workers identified above) a. New employment * d. New concurrent employment * Required Field Requir ed Field b. Continuation of previously approved employment * without change with the same employer c. Change in previously approved employment * Required Field f. Amended petition * Requir ed F ield 8. Nature of Temporary Need: (Choose only one of the standards) * … Seasonal … Peakload 9. Statement of Temporary Need * e. Change in employer * Required F ield Required Field Required F ield … One-Time Occurrence … Intermittent or Other Temporary Need Required Field ETA Form 9142 FOR DEPARTMENT OF LABOR USE ONLY Case Number: ______________________ Case Status: __________________ Page 1 of 6 Validity Period: ______________ to _______________ American LegalNet, Inc. www.FormsWorkFlow.com OMB Approval: 1205-0466 Expiration Date: 11/30/2011 Application for Temporary Employment Certification ETA Form 9142 U.S. Department of Labor C. Employer Information Important Note: Enter the full name of the individual employer, partnership, or corporation and all other required information in this section. For joint employer or master applications filed on behalf of more than one employer under the H-2A program, identify the main or primary employer in the section below and then submit a separate attachment that identifies each employer, by name, mailing address, and total worker positions needed, under the application. 1. Legal business name * Required Field 2. Trade name/Doing Business As (DBA), if applicable 3. Address 1 * Required F ield 4. Address 2 5. City * 6. State * Required Field Required Field 8. Country * 7. Postal code * Required Field 9. Province Requir ed F ield 10. Telephone number * 11. Extension Requir ed Field 12. Federal Employer Identification Number (FEIN from IRS) * 13. NAICS code (must be at least 4-digits) * 14. Number of non-family full-time equivalent employees 15. Annual gross revenue Required F ield Requir ed Field 16. Year established 17.. Type of employer application (choose only one box below) * Required Field … Individual Employer … H-2A Labor Contractor or Job Contractor … Association – Sole Employer (H-2A only) … Association – Joint Employer (H-2A only) … Association – Filing as Agent (H-2A only) D. Employer Point of Contact Information Important Note: The information contained in this Section must be that of an employee of the employer who is authorized to act on behalf of the employer in labor certification matters. The information in this Section must be different from the agent or attorney information listed in Section E, unless the attorney is an employee of the employer. For joint employer or master applications filed on behalf of more than one employer under the H-2A program, enter only the contact information for the main or primary employer (e.g., contact for an association filing as joint employer) under the application. 1. Contact’s last (family) name * 4. Contact’s job title * Requir ed F ield 2. First (given) name * 3. Middle name(s) * Requir ed Field Required Field Required Field 5. Address 1 * Required F ield 6. Address 2 7. City * 8. State * Required Field 10. Country * Required Field ETA Form 9142 Required Field 11. Province Required Field 12. Telephone number * 9. Postal code * 13. Extension Required Field 14. E-Mail address FOR DEPARTMENT OF LABOR USE ONLY Case Number: ______________________ Case Status: __________________ Page 2 of 6 Validity Period: ______________ to _______________ American LegalNet, Inc. www.FormsWorkFlow.com OMB Approval: 1205-0466 Expiration Date: 11/30/2011 Application for Temporary Employment Certification ETA Form 9142 U.S. Department of Labor E. Attorney or Agent Information (If applicable) 1. Is/are the employer(s) represented by an attorney or agent in the filing of this application ‰ Yes (including associations acting as agent under the H-2A program)? If “Yes”, complete Section E. * 3. First (given) name § 4. Middle name(s) § 2. Attorney or Agent’s last (family) name § ‰ No Required Field 5. Address 1 § 6. Address 2 7. City § 8. State § 10. Country § 11. Province 12. Telephone number § 13. Extension 9. Postal code § 14. E-Mail address 15. Law firm/Business name § 16. Law firm/Business FEIN § 17. State Bar number (only if attorney) § 18. State of highest court where attorney is in good standing (only if attorney) § 19. Name of the highest court where attorney is in good standing (only if attorney) § F. Job Offer Information a. Job Description 1. Job Title * Required F ield 2. Number of hours of work per week Basic *: _______ 3. Hourly Work Schedule * Requir ed F ield(Basic Hour s) Overtime: _______ Required Fiel d A.M. (h:mm): ___ : ____ 4. Does this position supervise the work of other employees? * ‰ Yes ‰ No Required Fiel d P.M. (h:mm): ___ : ____ 4a. If yes, number of employees worker will supervise (if applicable) § ______ 5. Job duties – A description of the duties to be performed MUST begin in this space. If necessary, add attachment to continue and complete description. * Required Fi eld ETA Form 9142 FOR DEPARTMENT OF LABOR USE ONLY Case Number: ______________________ Case Status: __________________ Page 3 of 6 Validity Period: ______________ to _______________ American LegalNet, Inc. www.FormsWorkFlow.com OMB Approval: 1205-0466 Expiration Date: 11/30/2011 Application for Temporary Employment Certification ETA Form 9142 U.S. Department of Labor F. Job Offer Information (continued) b. Minimum Job Requirements 1. Education: minimum U.S. diploma/degree required * Required Fiel d … None … High School/GED … Associate’s … Bachelor’s … Master's … Doctorate (PhD) … Other degree (JD, MD, etc.) 1a. If “Other degree” in question 1, specify the diploma/ 1b. Indicate the major(s) and/or field(s) of study required § (May list more than one related major and more than one field) degree required § 2. Does the employer require a second U.S. diploma/degree? * ‰ Yes ‰ No 2a. If “Yes” in question 2, indicate the second U.S. diploma/degree and the major(s) and/or field(s) of study required § Required Fiel d 3. Is training for the job opportunity required? * ‰ Yes Required Fi eld ‰ No 3a. If “Yes” in question 3, specify the number of months of training required § 3b. Indicate the field(s)/name(s) of training required § (May list more than one related field and more than one type) 4. Is employment experience required? * 4a. If “Yes” in question 4, specify the number of months of experience required § 4b. Indicate the occupation required § ‰ Yes Required Fi eld ‰ No 5. Special Requirements - List specific skills, licenses/certifications, and requirements of the job opportunity. * Required Fiel d c. Place of Employment Information 1. Worksite address 1 * Required Fi eld 2. Address 2 3. City * 4. County * Required Fiel d Required Fi eld 5. State/District/Territory * 6. Postal code * Required Fiel d Required Fi eld 7. Will work be performed in multiple worksites within an area of intended ‰ Yes ‰ No employment or a location(s) other than the address listed above? * 7a. If Yes in question 7, identify the geographic place(s) of employment with as much specificity as possible. If necessary, submit an attachment to continue and complete a listing of all anticipated worksites. § Required Fi eld ETA Form 9142 FOR DEPARTMENT OF LABOR USE ONLY Case Number: ______________________ Case Status: __________________ Page 4 of 6 Validity Period: ______________ to _______________ American LegalNet, Inc. www.FormsWorkFlow.com OMB Approval: 1205-0466 Expiration Date: 11/30/2011 Application for Temporary Employment Certification ETA Form 9142 U.S. Department of Labor G. Rate of Pay 1. Basic Rate of Pay Offered * 1a. Overtime Rate of Pay (if applicable) § Required Fi eld From: $ _____ . ____ To (Optional): 2. Per: (Choose only one) * $ _____ . ____ From: $ _____ . ____ To (Optional): $ _____ . ____ Required Field … Hour … Week … Bi-Weekly … Month … Year … Piece Rate 2a. If Piece Rate is indicated in question 2, specify the wage offer requirements: § 3. Additional Wage Information (e.g., multiple worksite applications, itinerant work, or other special procedures). If necessary, add attachment to continue and complete description. § H. Recruitment Information 1. Name of State Workforce Agency (SWA) serving the area of intended employment * 2. SWA job order identification number * 2a. Start date of SWA job order * Required Fi eld Required Fi eld Required Fiel d 2b. End date of SWA job order * Required Fi eld (In H-2A this date is 50% of contract period) 3. Is there a Sunday edition of a newspaper (of general circulation) in the area of intended employment? * Name of Newspaper/Publication (in area of intended employment for H-2B only) * 4. From: ‰ Yes ‰ No Required Fi eld 5. From: Dates of Print Advertisement § To: To: 6. Additional Recruitment Activities for H-2B program. Use the space below to identify the type(s) or source(s) of recruitment, geographic location(s) of recruitment, and the date(s) on which recruitment was conducted. If necessary, add attachment to continue and complete description. * Required Fi eld ETA Form 9142 FOR DEPARTMENT OF LABOR USE ONLY Case Number: ______________________ Case Status: __________________ Page 5 of 6 Validity Period: ______________ to _______________ American LegalNet, Inc. www.FormsWorkFlow.com OMB Approval: 1205-0466 Expiration Date: 11/30/2011 Application for Temporary Employment Certification ETA Form 9142 U.S. Department of Labor I. Declaration of Employer and Attorney/Agent In accordance with Federal regulations, the employer must attest that it will abide by certain terms, assurances and obligations as a condition for receiving a temporary labor certification from the U.S. Department of Labor. Applications that fail to attach Appendix A.2 or Appendix B.1 will be considered incomplete and not accepted for processing by the ETA application processing center. 1. For H-2A Applications ONLY, please confirm that you have read and agree to all the applicable terms, assurances and obligations contained in Appendix A.2. § ‰ Yes ‰ No ‰ N/A 2. For H-2B Applications ONLY, please confirm that you have read and agree to all the applicable terms, assurances and obligations contained in Appendix B.1. § ‰ Yes ‰ No ‰ N/A J. Preparer Complete this section if the preparer of this application is a person other than the one identified in either Section D (employer point of contact) or E (attorney or agent) of this application. 2. First (given) name § 1. Last (family) name § 3. Middle initial § 4. Job Title § 5. Firm/Business name § 6. E-Mail address § K. U.S. Government Agency Use (ONLY) Pursuant to the provisions of Section 101 (a)(15)(h)(ii) of the Immigration and Nationality Act, as amended, I hereby certify that there are not sufficient U.S. workers available and the employment of the above will not adversely affect the wages and working conditions of workers in the U.S. similarly employed. By virtue of the signature below, the Department of Labor hereby acknowledges the following: This certification is valid from _______________________ to _______________________. ______________________________________________ Department of Labor, Office of Foreign Labor Certification ______________________________ Determination Date (date signed) ______________________________________________ Case number ______________________________ Case Status L. OMB Paperwork Reduction Act (1205-0466) Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Respondent’s reply to these reporting requirements is mandatory to obtain the benefits of temporary employment certification (Immigration and Nationality Act, Section 101 (a)(15)(H)(ii)). Public reporting burden for this collection of information is estimated to average 1 hour per response for H2A and 2 hours 45 minutes for H-2B, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate to the Office of Foreign Labor Certification * U.S. Department of Labor * Room C4312 * 200 Constitution Ave., NW * Washington, DC * 20210. Do NOT send the completed application to this address. ETA Form 9142 FOR DEPARTMENT OF LABOR USE ONLY Case Number: ______________________ Case Status: __________________ Page 6 of 6 Validity Period: ______________ to _______________ American LegalNet, Inc. www.FormsWorkFlow.com