APPLICATION WISCONSIN FOREIGN LABOR CERTIFICATION Prevailing Wage Determination • • • • Submit completed request form via mail; fax or e-mail to: Department of Workforce Development ; Foreign Labor Certification; 201 East Washington Avenue; Room G100; Madison WI 53702 FAX to: 608 - 261-8506 E-Mail to jamie.duffin@dwd.wisconsin.gov Phone: (608) 266-7426 The information provided is to be used to complete the Application for Permanent Employment Certification Form ETA 9089 or for applications for temporary foreign labor, as appropriate. The employer is not required to submit this form with the application, but required to retain the document for a period of five years. Requester and Employer Name (Full Name of Organizations) Requester Employer Requester Telephone & FAX No. PHONE ( FAX Requester Mailing Address City & State Where Alien Will Work ) ) ( Nature of Employer’s Business Activity Job Title Total Hours Per Week Basic Overtime Work Schedule Will Alien Supervise/ Lead Employees? ________ AM ________ PM Fully Describe Job Duties -- include lead worker/supervisory duties when applicable Detail the MINIMUM education, training and experience required for a worker to satisfactorily perform the job duties described. EDUCATION Grade School High School College/ Univ. Years Years Specify College Degree & Major Field of Study Requirements Years FORMAL TRAINING Other Requirements (Licenses, Certificates, Languages, etc.) Years Months Type of Training EXPERIENCE Job and/ Offered Years Months or Related Occupation Years Specify Related Occupation Months PREVAILING WAGE (COMPLETED BY ALC UNIT) This Prevailing wage is valid for filing applications and attestations for 180 days from the date of the determination. Analyst Signature r:PrvWge.D(R.04/09) Determination Date American LegalNet, Inc. www.FormsWorkFlow.com