OMB Approval: 1205-0508
Expiration Date: 03/31/2016
Application for Prevailing Wage Determination
ETA Form 9141
U.S. Department of Labor
ETA Form 9141 FOR DEPARTMENT OF LABOR USE ONLY Page 3 of 4
PW Tracking Number:___________________ Case Status: __________________ Validity Period: ______________ to _______________
E. Job Offer Information (cont.)
b. Minimum Job Requirements:
1. Education: minimum U.S. diploma/degree required *
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/
degree required §
1b. Indicate the major(s) and/or field(s) of study required
§
(May list more than one related major and more than one field)
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
§
3. Is training for the job opportunity required? * Yes 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? * Yes No
4a. If “Yes” in question 4, specify the number of
months of experience required §
4b. Indicate the occupation required
§
5. Special Requirements - List specific skills, licenses/certificates/certifications, and requirements of the
job opportunity. *
c. Place of Employment Information:
5. State/District/Territory *
7. Will work be performed in multiple worksites within an area of intended
employment or a location(s) other than the address listed above? *
Yes No
7a. If “Yes”, identify the geographic place(s) of employment indicating each metropolitan statistical area (MSA) or the
independent city(ies)/township(s)/county(ies) (borough(s)/parish(es)) and the corresponding state(s) where work will be
performed. If necessary, submit a second completed ETA Form 9141 with a listing of the additional anticipated worksites.
Please note that wages cannot be provided for unspecified/unanticipated locations.
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