18. COMPLETE ITEMS ONLY IF JOB IS TEMPORARY
19. IF JOB IS UNIONIZED (Complete)
b. Exact Dates You Expect
To Employ Alien
From To
b. Nam e of Local
a. No. of Open-
ings To Be
Filled by Aliens
Under Job Offer
a. Number
of
Local
c. City and State
20. STATEMENT FOR LIVE-AT-WORK JOB OFFERS (Complete for Private Household ONLY)
a. Description of Residence b. No. Persons residing at Place of Employment
Children Ages
BOYS
(“X” one)
House
Apartment
Number of
Rooms
Adults
GIRLS
c. Will free board and private (“X” one)
room not shared with any-
one be provided?
YES NO
21. DESCRIBE EFFORTS TO RECRUIT U.S. WORKERS AND THE RESULTS. (Specify Sources of Recruitment by Name)
22. Applications require various types of documentation. Please read Part II of the instructions to assure that appropriate
supporting documentation is included with your application.
23. EMPLOYER CERTIFICATIONS
By virtue of my signature below, I HEREBY CERTIFY the following conditions of employment.
a. I have enough funds available to pay the wage
or salary offered the alien.
b. The wage offered equal or exceeds the pre-
vailing wage and I guarantee that, if a labor certi-
fication is granted, the wage paid to the alien when
the alien begins work will equal or exceed the pre-
vailing wage which is applicable at the time the
alien begins work.
c. The wage offered is not based on commissions,
bonuses, or other incentives, unless I guarantee
a wage paid on a weekly, bi-weekly, or monthly
basis.
d. I will be able to place the alien on the payroll
on or before the date of the alien’s proposed
entrance into the United States.
e. The job opportunity does not involve unlawful discri-
mination by race, creed, color, national origin, age,
sex, religion, handicap, or citizenship.
f. The job opportunity is not:
(1) Vacant because the former occupant is on
strike or is being locked out in the course of
a labor dispute involving a work stoppage.
(2) At issue in a labor dispute involving a work
stoppage.
g. The job opportunity’s terms, conditions and occupa-
tional environment are not contrary to Federal,
State or local law.
h. The job opportunity has been and is clearly open to
any qualified U.S. worker.
24. DECLARATIONS
DECLARATION
OF Pursuant to 28 U.S.C. 1746, I declare under penalty of perjury the foregoing is true and correct.
EMPLOYER
SIGNATURE
DATE
NAME (Type or Print)
TITLE
EMAIL ADDRESS
CONTACT TELEPHONE
FAX TELEPHONE
AUTHORIZATION OF I HEREBY DESIGNATE the agent below to represent me for the purposes of labor certification and I TAKE FULL
AGENT OF EMPLOYER RESPONSIBILITY for accuracy of any representations made by my agent.
SIGNATURE OF EMPLOYER
DATE
NAME OF AGENT (Type or Print)
ADDRESS OF AGENT (Number, Street, City, State, ZIP code)
EMAIL ADDRESS
CONTACT TELEPHONE
FAX TELEPHONE
OMB No.: 1205-0015 OMB Burden Hours averages 1.5 hours. OMB Burden Statement: These reporting instructions have been approved under the Paperwork Reduction
Act of 1995. Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Obligations to reply are mandatory. (Title 8 U.S.C. §§ 1882, 1884,
and 1188) Public reporting burden for this collection of information, which is to assist with planning and program management, includes the time to review instructions, search existing data sources, gather
and maintain the data needed, and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to the U.S. Department of Labor, Room C-4312, 200 Constitution Ave. NW, Washington, DC 20210. (Paperwork Reduction Project OMB 1205-0015.)
