Fillable Form ETA-9141: A. Employment-Based Visa Information 1. Indicate (Department of Labor)

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Form ETA-9141: A. Employment-Based Visa Information 1. Indicate (Department of Labor)

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OMB Approval: 1205-0508
Expiration Date: 09/30/2022
Application for Prevailing Wage Determination
Form ETA-9141
U.S. Department of Labor
Please read and review the filing instructions carefully before completing the Form ETA-9141. A copy of the instructions can be found at
https://www.dol.gov/agencies/eta/foreign-labor. For all submissions, either electronic or paper, ALL required fields/items containing an asterisk (*)
must be completed as well as any applicable fields/items where a response is conditional as indicated by the section (§) symbol.
A.
Employment-Based Visa Information
1. Indicate the type of visa classification supported by this application (Write classification symbol): *
B.
Employer Point-of-Contact Information
Important Note: The information contained in this section is for an employee authorized to act on behalf of the employer in labor certification or labor
condition application matters. The information in this section must be different from the attorney or agent information listed in Section D, except when an
attorney listed in Section D is an employee of the employer.
1. Contact’s Last (family) Name *
2. First (given) Name *
4. Contact’s job title *
5. Address 1 *
6. Address 2
7. City *
8. State *
10. Country *
11. Province (if applicable) §
12. Telephone number *
13. Extension (if applicable) §
14. Business E-Mail Address *
C.
Employer Information
1. Legal Business Name *
2. Trade Name/Doing Business As (DBA), if applicable §
3. Address 1 *
4. Address 2
5. City *
6. State *
7. Postal code *
8. Country *
9. Province (if applicable) §
10. Telephone number *
11. Extension (if applicable) §
12. Federal Employer Identification Number (FEIN from IRS) *
13. NAICS code *
D.
Attorney or Agent Information (if applicable)
1. Indicate the type of representation for the employer in the filing of this application *
If D.1 is “Attorney” or “Agent” the remainder of this section is required
Attorney Agent None
2. Attorney or Agent’s Last (family) Name §
3. First (given) Name §
4. Middle Name(s) §
5. Address 1 §
Form ETA-9141
FOR DEPARTMENT OF LABOR USE ONLY
Page 1 of 5
PWD Case Number: Case Status: Validity Period: to
OMB Approval: 1205-0508
Expiration Date: 09/30/2022
Application for Prevailing Wage Determination
Form ETA-9141
U.S. Department of Labor
6. Address 2
(apartment/suite/floor and number)
7. City §
8. State §
9. Postal Code §
10. Country §
11. Province (if applicable) §
12. Telephone Number §
13. Extension §
14. Law Firm/Business E-Mail Address §
15. Law Firm/Business Name §
16. Law Firm/Business FEIN §
E.
Wage Source Information
Refer to instructions for all supporting documents required in this section.
1. Is the employer covered by ACWIA, as described in 20 CFR 656.40(e)(1)? * (Not applicable for H-
2B)
Yes No N/A
a. If “Yes,” identify which ACWIA provision the employer is covered under (choose all that apply): §
(i) Institution of higher education
(ii) Affiliated or related nonprofit entity connected or associated with an institution of higher education
(iii) Nonprofit research organization or Governmental research organization
b. If the employer has previously been determined not covered under ACWIA, does the employer
have any reason to believe that its status has changed?
§
Yes
No
N/A
2. Is the position covered by a Professional Sports League Rules or Regulations? §
Yes No
3. Is the position covered by a Collective Bargaining Agreement (CBA)? §
Yes
No
N/A
For non-OES requests, select and fully complete only one of the following: (Davis Bacon Act (DBA) & Service Contract Act (SCA) are not
prevailing wage sources for H-2B)
4. Source Type: § DBA SCA Survey
a. Complete the following if consideration of a survey is requested above. § (If this is a request to use a survey in the H-2B program,
Form ETA-9165 must also be completed.)
(i) Survey name or title: §
(ii) Survey date of publication or, if not published, date of submission to DOL:
§
F.
Job Offer Information
a.
Job Description
1. Job Title *
2. Job Duties: Description of the specific services or labor to be performed. * (All job duties must be disclosed. A description of the job duties
MUST begin in this space. One separate addendum will be accepted to fully compete the response.)
3. Does this position supervise the work of other employees? *
Yes No
a. If “Yes,” please indicate the SOC code(s) and SOC title(s) of the occupation(s) of the employees to be supervised: §
Form ETA-9141
FOR DEPARTMENT OF LABOR USE ONLY
Page 2 of 5
PWD Case Number: Case Status: Validity Period: to
OMB Approval: 1205-0508
Expiration Date: 09/30/2022
Application for Prevailing Wage Determination
Form ETA-9141
U.S. Department of Labor
b.
Minimum Job Requirements
1. Education: Minimum U.S. diploma/degree required *
None High School/GED Associate’s Bachelor’s Master’s Doctorate (Ph.D.) Other degree (J.D., M.D., etc.)
a. If “Other degree” in question 1, specify the U.S.
diploma/degree required §
b. 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
a. 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
a. If “Yes” in question 3, specify the number of months of
training required §
b. 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
a. If “Yes” in question 4, specify the number of months of
experience required §
b. Indicate the occupation required §
5. Special Skills or Other Requirements: Does the employer require any specific or other requirements? * Yes No
a. If “Yes,” check all that apply and specify the requirement(s): §
(i) License/Certification:
(ii) Foreign Language:
(iii) Residency/Fellowship:
(iv) Other Special Skills or Requirements:
c.
Alternative Job Requirements
While an employer may specify alternative requirements, the substantial equivalency of the alternative requirements to minimum requirements will not
be evaluated. (Not applicable for H-2
B)
1. Are alternate sets of Education, Training, and/or Experience accepted? §
Yes No
If c.1 is “Yes,” c.2, c.3, and c. 4 must be completed.
2. Specify the alternate level of education: U.S. diploma/degree accepted §
None High School/GED Associate’s Bachelor’s Master’s Doctorate (Ph.D.) Other degree (J.D., M.D., etc.)
a. If “Other degree” in question 2, specify the U.S.
diploma/degree accepted §
b. Indicate the major(s) and/or field(s) of study accepted § (May list
more than one related major and more than one field)
3. Is alternate training for the job opportunity accepted? § Yes No
a. If “Yes” in question 3, specify the number of
months of alternate training accepted §
b. Indicate the field(s)/name(s) of training accepted §
(May list more than one related field and more than one type)
4. Is alternate employment experience accepted? §
Yes No
Form ETA-9141
FOR DEPARTMENT OF LABOR USE ONLY
Page 3 of 5
PWD Case Number: Case Status: Validity Period: to
OMB Approval: 1205-0508
Expiration Date: 09/30/2022
Application for Prevailing Wage Determination
Form ETA-9141
U.S. Department of Labor
a. If “Yes” in question 4, specify the number of months of alternate experience accepted §
5. Special Skills or Other Requirements: Does the employer require any specific or other requirements? *
Yes No
a. If “Yes,” check all that apply and specify the requirement(s) §
(i) License/Certification:
(ii) Foreign language:
(iii) Residency/Fellowship:
(iv) Other Special Skills or Requirements:
d. Other Information
1. Suggested SOC (O*NET/OES) code *
a. Suggested SOC (O*NET/OES) occupation title *
2. Job title of the official the employee will report to for this job opportunity (if applicable) §
3. Will travel be required in order to perform the job duties? *
Yes No
a. If “Yes,” provide geographic location and frequency of the travel. §
e. Place of Employment Information
1. Worksite address 1 *
2. Address 2
3. City *
4. State *
5. County *
6. Postal Code *
7. Will work be performed in any Bureau of Labor Statistics Area (Metropolitan or Non-Metropolitan
Statistical Areas) other than the Bureau of Labor Statistics Area of the address listed above, or, in the case of
Bureau of Labor Statistics areas with multiple county-level prevailing wage rates, in a county other than the
county of the address listed above? * (If “Yes,” a completed Appendix A is required)
Yes No
Form ETA-9141
FOR DEPARTMENT OF LABOR USE ONLY
Page 4 of 5
PWD Case Number: Case Status: Validity Period: to
Application for Prevailing Wage Determination
Form ETA-9141
U.S.
Department of Labor
OMB Approval: 1205-0508
Expiration Date: 09/30/2022
G.
Prevailing Wage Determination
FOR OFFICIAL GOVERNMENT USE ONLY
1. PWD Tracking Number
2. PW Receipt Date
3. SOC Code: a. SOC Occupation Title:
While all prevailing wages are issued at the six digit SOC code level, O*NET includes extended eight digit occupations. If applicable, the
O*NET eight-digit extension code is listed below.
b. O*NET Code:
c. O*NET Occupation Title:
When the job opportunity represents a combination of occupations, listed below are the other occupations.
d. O*NET Code:
e. O*NET Occupation Title:
4. Prevailing wage: (based on the primary worksite location. See Item 6 below for details). For H-1B, H-1B1, E-3, and PERM only, this wage is based
on the minimum job requirements for the position. $___________.______
a. Per: (Choose only one)
Hour Week Bi-Weekly Month Year
b. OES Wage level: I II III IV OES Mean N/A
c. Prevailing wage source (Choose only one):
OES (A
ll
Industries) OES (ACWIA, does not apply
to H-2B)
CB
A
DB
A
S
CA
A
l
t
ernate Survey
Professional Sports League Rules or Regulations
d. If “Survey” in question 4c, specify the name of the survey:
5. Prevailing wage: (based on the primary worksite location. See Item 6 below for details). For H-1B, H-1B1, E-3, and PERM only. T
his
wage is based on the alternative job requirements for the position (does not apply to H-2B). $___________.______
a. Per: (Choose only one)
Hour Week Bi-Weekly Month Year
b. OES Wage level: I II III IV OES Mean N/A
c. Prevailing wage source (Choose only one):
OES (A
ll
Industries) OES (ACWIA)
CB
A
DB
A
S
CA
A
l
t
ernate Survey
Professional Sports League Rules or Regulations
d. If “Survey” in question 5c, specify the name of the survey:
6. The wage is based on the following BLS Area (Metropolitan or Non-Metropolitan Statistical Area):
7. The highest PWD out of all H-2B worksites for which a prevailing wage determination was requested: $___________.____ per hour.
8. Additional Notes Regarding Wage Determination:
9. Determination date: 10. Expiration date:
H.
OMB Paperwork Reduction Act (1205-0508)
Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Your response is required to
receive the benefit of consideration of this application. (Immigration and Nationality Act, Section 101). Public reporting burden for this collection of
information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. The burden estimate is as follows: 9141- 47 minutes, Appendix
A- 3 minutes, and recordkeeping- 10 minutes. Send comments regarding this burden estimate to the Office of Foreign Labor Certification * U.S.
Department of Labor * Box PPII 12 - 200 * 200 Constitution Ave., NW * Washington, DC * 20210. Do NOT send the completed application to this
address.
Form ETA-9141
FOR DEPARTMENT OF LABOR USE ONLY
Page 5 of 5
PWD Case Number: Case Status: Validity Period: to
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Form ETA-9141: A. Employment-Based Visa Information 1. Indicate (Department of Labor)

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Completed 28 December 2022

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