OMB No. 1205-0309
Expiration Date: 01/31/2020
Employers’ Attestation to Use Alien Crewmembers for
Longshore Activities in the State of Alaska
Form ETA 9033-A
U.S. Department of Labor
Form ETA 9033-A FOR DEPARTMENT OF LABOR USE ONLY Page 3 of 4
Case Number: ________________ Case Status: __________________Validity Period: ______________ to _______________
GENERAL INSTRUCTIONS
IMPORTANT: Please read these instructions carefully before completing the form. These instructions contain full explanations of the questions and
attestations that make up the Form ETA 9033-A. In accordance with Federal Regulations, incomplete or obviously inaccurate applications
will not be accepted by the Department of Labor.
Submit the completed original Form ETA 9033-A with accompanying documentation along with two copies of the form and accompanying
documentation. Attestation must be received by the Department of Labor no later than 30 days prior to the first performance of the longshore activity
(or anytime up to 24 hours before the first performance on the activity upon a showing that the employer could not have reasonably anticipated the
need to file an attestation for that location at the time). Attestations which are filed less than 30 days prior to the first performance of the longshore
activity must include supporting documentation to show that the employer could not have reasonably anticipated the need to file attestation for that
location at that time. Attestations must be submitted to the Office of Foreign Labor Certification, Employment and Training Administration, U.S.
Department of Labor, 11 West Quincy Court, Chicago, IL 60604-2105. An employer may file a single attestation for multiple locations in the
State of Alaska.
Anyone, who knowingly and willingly furnishes any false information in the preparation of Form ETA 9033-A and an
y supporting documentation, or
aids, abets, or counsels another to do so is committing a federal offense, punishable by fine or imprisonment up to five years or both (18 U.S.C. §§
2, 1001). Other penalties apply as well to fraud or misuse of this immigration document and to perjury with respect to this form (18 U.S.C. §§ 1546,
1621).
Section A. Employer Information
1.
Enter the full legal name of a business, firm or organization, or if an
individual, enter name used for legal purposes on
documents.
2.
Enter the full trade name or “Doi
ng Business As” (DBA) name, if
applicable, of the
business, person, association, firm, corporation, or
organization, i.e., the employer filing this applicatio
n.
3.
Enter the street address of the employer’s principal place of
business.
4.
If additional space is needed for the street address, use this line to
complete the employer’s street ad
dress.
5.
Enter the city of the employer’s prin
cipal place of business. If the city
and country
are the same, the name must still be entered in bot
h
fields.
6.
Enter the state of the employer’s principal place of business.
7.
Enter the postal (zip) code of the employer’s principal place
of
business.
8.
Enter the country of the employer’s principal place of business.
9.
Enter the province of the employer’s principal place of business, if
applicable.
10.
Enter the area code and telephone number for the employer
’s
principal place of business. Includ
e country code
, if applicable.
11.
Enter the e-mail address of the employer po
int of contact in the
format name
@em
ailaddress.top-level domain.
12. Enter name of the employer point of contact. An employer point of
contact is an employee of the employer wh
ose position authorizes
the emplo
yee to provide information and supporting documentatio
n
concerning this
Employer’s Attestation to Use Alien Crewmember
s
for Longsho
re Activities in the State of Alaska and to communicate
with the Department of Labor on behalf of the employer. Th
e
emplo
yer point of contact should be the individual most familiar with
the content of this application and circumstances of the foreig
n
w
orker’s employ
ment.
13.
Enter the job title of the employer
point of contact.
Section B. Employer’s U.S. Agent or Representative Information
(if applicable)
Note: The U.S. agent/representative information in this Section,
specifically the name, telephone number, and e-mail address, must be
different from the employer point of contact information in Section A.
1.
Enter the full name of the agent/representative.
2.
Enter the street address of the attorney/agent (add
ress must be a
U.S. address).
3.
Enter the city of the attorney/agen
t.
4.
Enter the state of the attorney/age
nt.
5.
Enter the postal (zip) code of the attorney
/agent.
6.
Enter the area code and telephone number of the attorney/agent.
7.
Enter the extension of the telephone number of the attorney/agent
, if
applicable.
8.
Enter the e-mail address of the attorney/agent in t
he format
name@emailaddress.top-level domain.
Section C. Location(s) and Job Information in State of Alaska
Employer may file a single Form ETA 9033-A for multiple locations in
the State of Alaska. Use attachments if additional space is needed.
1.
Enter the name of the port(s), and the city(ies)
in the State of
Alaska in w
h
ich the port is located.
2.
Enter the date of the first performance of the longshore activity
.
3.
Check appropriate box if claiming an unanticipated
need.
4.
Enter an estimate of the total number of crewmembers that the
employer anticipates requesting for the activity
specified for this
attestation.
5.
Longshore work is defined as activity relating to (1) loading of
cargo, (2) unloading of cargo, (3) operation of cargo-related
equipment, and (4) handling of mooring lines on the dock wh
en a
vessel is made
fast or let go. The employer mu
st check each
activity
it intends to perfo
rm.
6.
Provide the qualifications required to perform ea
ch of the job(s)
identified in C.5.
Sectio
n D. Employer Attestation
See 20 CFR § 655.534 through 655.537 of the regulations for guidance
on the documentation that must be developed and maintained to meet
the employer’s burden of proof under the attestation elements.
1.
Bona Fide Request for Dispatch of U.S. Longshore
Workers.
The employer must attest that, before using alien crewmen to
perform longshore work, it will make a bona fide request for th
e
U.S. longshore
workers who
are qualified and available in
sufficient numbers to p
erform the activity at the particular times
and locations specified. The request for dispatch must be directed
to the parties to whom notice of filing is provided under attestation
element D.4 (ii) and (iii). Wherever two and more contract
stevedoring companies have signed a joint colle
ctive bargaining
agreement
with a labor organization described
in attestation
element D.1 (i), the emplo
yer may request longshore workers from
only one of such contract stevedoring company. A request for
longshore workers to an operator of a private dock may be made
only for longshore work to be performed at that dock and only if the
operator meets the requirements of section 32 of the Longshore
and Harbor Workers’ Compensation Act (33 U.S.C. 932). See §
655.534 of the regulations for a
detailed explanation of this
attestation element.
2.
Employment of U.S. Longshore Workers. The employer must
attest that all U.S. longshore workers made available in response
to the request for dispatch under the first attestation element, item
D.1, who are qualified and available in sufficient number and who
are needed to perform the longshore activity at the particular times
and locations specified will be employed to perform such activity.
See § 655.535 of the regulations for a detailed explanation of this
attestation element.
