Fillable Form ETA-9142A: H-2A Application For Temporary Employment Certification (Visa Pro)

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Form ETA-9142A: H-2A Application For Temporary Employment Certification (Visa Pro)

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OMB Approval: 1205-0466
Expiration Date: 05/31/2019
H-2A Application for Temporary Employment Certification
Form ETA-9142A
U.S. Department of Labor
Form ETA-9142A FOR DEPARTMENT OF LABOR USE ONLY Page 1 of 6
Case Number: ______________________ Case Status: __________________ Validity Period: ______________ to _______________
Please read and review the filing instructions carefully before completing the Form ETA-9142A. A copy of the instructions can be
found at http://www.foreignlaborcert.doleta.gov/. In accordance with Federal Regulations, incomplete or obviously inaccurate
applications will not be certified by the Department of Labor. If submitting this form non-electronically, ALL required fields/items
containing an asterisk ( * ) must be completed as well as any fields/items where a response is conditional as indicated by the section (
§ ) symbol.
A. Employment-Based Nonimmigrant Visa Information
1. Indicate the type of visa classification supported by this application (Write classification symbol): *
B. Temporary Need Information
1. Job Title *
2. SOC (ONET/OES) code *
3. SOC (ONET/OES) occupation title *
4. Is this a full-time position? *
Yes No
Period of Intended Employment
5. Begin Date *
(mm/dd/yyyy)
7. Worker positions needed/basis for the visa classification supported by this application
Total Worker Positions Being Requested for Certification *
Basis for the visa classification supported by this application
(indicate the total workers in each applicable category based on the total workers identified above)
a. New employment * d. New concurrent employment *
b. Continuation of previously approved employment * e. Change in employer *
without change with the same employer
c. Change in previously approved employment * f. Amended petition *
8. Nature of Temporary Need: (Choose only one of the standards) *
Seasonal Peakload One-Time Occurrence Intermittent or Other Temporary Need
9. Statement of Temporary Need *
OMB Approval: 1205-0466
Expiration Date: 05/31/2019
H-2A Application for Temporary Employment Certification
Form ETA-9142A
U.S. Department of Labor
Form ETA-9142A FOR DEPARTMENT OF LABOR USE ONLY Page 2 of 6
Case Number: ______________________ Case Status: __________________ Validity Period: ______________ to _______________
C. Employer Information
Important Note: Enter the full name of the individual employer, partnership, or corporation and all other required information in this section.
For joint employer or master applications filed on behalf of more than one employer under the H-2A program, identify the main or primary
employer in the section below and then submit a separate attachment that identifies each employer, by name, mailing address, and total
worker positions needed, under the application.
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
10. Telephone number *
11. Extension
12. Federal Employer Identification Number (FEIN from IRS) *
13. NAICS code (must be at least 4-digits) *
14. Number of non-family full-time equivalent employees
15. Annual gross
revenue
16. Year established
17. Type of employer application (choose only one box below) *
Individual Employer Association – Sole Employer (H-2A only)
H-2A Labor Contractor or Association – Joint Employer (H-2A only)
Job Contractor Association – Filing as Agent (H-2A only)
D. Employer Point of Contact Information
Important Note: The information contained in this Section must be that of an employee of the employer who is authorized to act on behalf of
the employer in labor certification matters. The information in this Section must be different from the agent or attorney information listed in
Section E, unless the attorney is an employee of the employer. For joint employer or master applications filed on behalf of more than one
employer under the H-2A program, enter only the contact information for the main or primary employer (e.g., contact for an association filing
as joint employer) under the application.
1. Contact’s last (family) name *
2. First (given) name
3. Middle name(s)
4. Contact’s job title *
5. Address 1 *
6. Address 2
7. City *
8. State *
9. Postal code *
10. Country *
11. Province
12. Telephone number *
13. Extension
14. E-Mail address
OMB Approval: 1205-0466
Expiration Date: 05/31/2019
H-2A Application for Temporary Employment Certification
Form ETA-9142A
U.S. Department of Labor
Form ETA-9142A FOR DEPARTMENT OF LABOR USE ONLY Page 3 of 6
Case Number: ______________________ Case Status: __________________ Validity Period: ______________ to _______________
E. Attorney or Agent Information (If applicable)
1. Is/are the employer(s) represented by an attorney or agent in the filing of this application
(including associations acting as agent under the H-2A program)? If “Yes”, complete Section E. *
Yes No
2. Attorney or Agent’s last (family) name §
3. First (given) name §
4. Middle name
5. Address 1 §
6. Address 2
7. City §
8. State
9. Postal code §
10. Country §
11. Province
12. Telephone number §
13. Extension
14. E-Mail address
15. Law firm/Business name §
16. Law firm/Business FEIN §
17. State Bar number (only if attorney) §
18. State of highest court where attorney is in good
standing (only if attorney) §
19. Name of the highest court where attorney is in good standing (only if attorney) §
F. Job Offer Information
a. Job Description
1. Job Title *
2. Number of hours of work per week
Basic *: _______ Overtime: _______
3. Hourly Work Schedule *
A.M. (h:mm): ___ : ____ P.M. (h:mm): ___ : ____
4. Does this position supervise the work of other employees? *
Yes No
4a. If yes, number of employees
worker will supervise (if applicable) § ______
5. Job duties – A description of the duties to be performed MUST begin in this space. If necessary, add attachment
to continue and complete description. *
OMB Approval: 1205-0466
Expiration Date: 05/31/2019
H-2A Application for Temporary Employment Certification
Form ETA-9142A
U.S. Department of Labor
Form ETA-9142A FOR DEPARTMENT OF LABOR USE ONLY Page 4 of 6
Case Number: ______________________ Case Status: __________________ Validity Period: ______________ to _______________
F. Job Offer Information (continued)
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/certifications, and requirements of the job opportunity. *
c. Place of Employment Information
1. Worksite address 1 *
2. Address 2
3. City *
4. County *
5. State/District/Territory *
6. Postal code *
7. Will work be performed in multiple worksites within an area of intended
employment or at location(s) other than the address listed above? *
Yes No
7a. If Yes in question 7, identify the geographic place(s) of employment with as much specificity as possible. If necessary,
submit an attachment to continue and complete a listing of all anticipated worksites. §
OMB Approval: 1205-0466
Expiration Date: 05/31/2019
H-2A Application for Temporary Employment Certification
Form ETA-9142A
U.S. Department of Labor
Form ETA-9142A FOR DEPARTMENT OF LABOR USE ONLY Page 5 of 6
Case Number: ______________________ Case Status: __________________ Validity Period: ______________ to _______________
G. Rate of Pay
1. Basic Rate of Pay Offered *
From: To (Optional):
1a. Overtime Rate of Pay (if applicable) §
From: To (Optional):
2. Per: (Choose only one) *
Hour Week Bi-Weekly Month Year Piece Rate
2a. If Piece Rate is indicated in question 2, specify the wage offer requirements: §
3. Additional Wage Information (e.g., multiple worksite applications, itinerant work, or other special procedures).
If necessary, add attachment to continue and complete description. §
H. Recruitment Information
1. Name of State Workforce Agency (SWA) serving the area of intended employment *
2. SWA job order identification number
2a. Start date of SWA job order *
2b. End date of SWA job order *
3. Is there a Sunday edition of a newspaper (of general circulation) in
the area of intended employment? *
□ Yes □ No
Name of Newspaper/Publication (in area of intended employment for H-2B only)*
Dates of Print Advertisement §
4.
From:
To:
5.
From:
To:
6. Additional Recruitment Activities for H-2B program. Use the space below to identify the type(s) or source(s) of recruitment,
geographic location(s) of recruitment, and the date(s) on which recruitment was conducted. If necessary, add attachment
to continue and complete description. *
$ _____ . ____
$ _____ . ____
$ _____ . ____
$ _____ . ____
OMB Approval: 1205-0466
Expiration Date: 05/31/2019
H-2A Application for Temporary Employment Certification
Form ETA-9142A
U.S. Department of Labor
Form ETA-9142A FOR DEPARTMENT OF LABOR USE ONLY Page 6 of 6
Case Number: ______________________ Case Status: __________________ Validity Period: ______________ to _______________
I. Declaration of Employer and Attorney/Agent
In accordance with Federal regulations, the employer must attest that it will abide by certain terms, assurances and obligations as a condition
for receiving a temporary labor certification from the U.S. Department of Labor. Applications that fail to attach Appendix A or Appendix B will be
considered incomplete and not accepted for processing by the ETA application processing center.
1. For H-2A Applications ONLY, please confirm that you have read and agree to all the
applicable terms, assurances and obligations contained in Appendix A. §
Yes No N/A
2. For H-2B Applications ONLY, please confirm that you have read and agree to all the
applicable terms, assurances and obligations contained in Appendix B.. §
Yes No N/A
J. Preparer
Complete this section if the preparer of this application is a person other than the one identified in either Section D (employer point of contact) or
E (attorney or agent) of this application.
1. Last (family) name §
2. First (given) name §
3. Middle name
4. Job Title §
5. Firm/Business name §
6. E-Mail address §
K. U.S. Government Agency Use (ONLY)
Pursuant to the provisions of Section 101 (a)(15)(h)(ii) of the Immigration and Nationality Act, as amended, I hereby
certify that there are not sufficient U.S. workers available and the employment of the above will not adversely affect the
wages and working conditions of workers in the U.S. similarly employed. By virtue of the signature below, the
Department of Labor hereby acknowledges the following:
This certification is valid from _______________________ to ___________________________.
______________________________________________ ______________________________
Department of Labor, Office of Foreign Labor Certification Determination Date (date signed)
______________________________________________ ______________________________
Case number Case Status
Public Burden Statement (1205-0466)
Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Public reporting
burden for this collection of information is estimated to average 1 hour to complete the form, 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
obligation to respond to this data collection is required to obtain/retain benefits (Immigration and Nationality Act, 8 U.S.C. 1101, et seq.).
Please send comments regarding this burden estimate or any other aspect of this information collection to the Office of Foreign Labor
Certification * U.S. Department of Labor * Box 12-200 * 200 Constitution Ave., NW, * Washington, DC *. Please do not send the completed
application to this address.
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Form ETA-9142A: H-2A Application For Temporary Employment Certification (Visa Pro)

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Completed 29 July 2020

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