Fillable Form ETA-9142C: New employment Renewal of approved employment (Department of Labor)

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Form ETA-9142C: New employment Renewal of approved employment (Department of Labor)

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OMB Approval: 1205-0534
Expiration Date: 10/31/2021
CW-1 Application for Temporary Employment Certification
Form ETA-9142C
U.S. Department of Labor
IMPORTANT: Employers and authorized preparers must read the general instructions carefully before completing the Form ETA-9142C. A copy of the instructions
can be found at http://www.foreignlaborcert.doleta.gov/. If you are not submitting this electronically, please complete ALL required fields/items containing an asterisk
(*) and any fields/items where a response is conditional as indicated by the section (§) symbol.
A. Nature of CW-1 Application
1. Type of Application (choose only one) *
New employment Renewal of approved employment
2. CW-1 Permit Renewal: If “Renewal of approved employment” is marked in Question A.1, enter
the date on which the CW-1 visa status of the nonimmigrant worker(s) will expire. §
3. Long-Term Worker: Is the employer seeking to employ a long-term worker who was previously
issued a CW-1 visa or otherwise granted CW-1 status, as defined in 20 CFR 655.402? *
Yes No
4. Cap-Exempt Worker: Will any of the CW-1 workers employed under this application be exempt
from the statutory numerical limit, or “cap,” on the total number of foreign nationals who may be
issued a CW-1 visa or otherwise granted CW-1 status? *
Yes No
5. Emergency Situation: Is the employer requesting to waive the requirement to obtain a valid PWD
prior to the filing of this application due to an emergency situation, as set forth in 20 CFR 655.
422? *
Yes No
FOR EMERGENCY SITUATIONS ONLY
If “Yes” is marked in question A.5, mark questions 6 and 7 below and include the required items.
6. Is a statement justifying the employer’s emergency situation attached to this
application? §
Yes No N/A
7. Is a completed Form ETA-9141C, Application for Prevailing Wage Determination (PWD application),
attached to this application? If the employer has submitted its PWD application for processing,
select “No” and enter the PWD case number in E.3. §
Yes No N/A
B. Employer Information
1. Legal Business Name *
2. Trade Name/Doing Business As (DBA), if applicable §
3. Address 1 *
4. Address 2 (apartment/suite/floor and number) §
5. City *
6. State *
7. Postal Code *
8. Country *
10. Telephone Number *
12. Federal Employer Identification Number (FEIN from IRS) *
13. NAICS Code *
14. Type of Employer (Choose only one) *
Individual Employer Job Contractor – Joint Employer
FOR JOB CONTRACTORS ONLY
If “Job Contractor – Joint Employer” is marked in question B.14, mark questions 15 and 16 below
and include the required items.
15. A completed Appendix A identifying the employer-client is attached to this application. §
16. An executed contract or other agreement between the job contractor and the employer-client establishing a bona
fide relationship to the workers sought under this application is attached.
§
Form ETA-9142C FOR DEPARTMENT OF LABOR USE ONLY Page 1 of 5
CW-1 Case Number: __________________ Case Status: __________________ Determination Date: _____________ Validity Period: _____________ to _____________
OMB Approval: 1205-0534
Expiration Date: 10/31/2021
CW-1 Application for Temporary Employment Certification
Form ETA-9142C
U.S. Department of Labor
C. Employer Point of Contact Information
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 D, unless the attorney is an employee of the employer.
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 (apartment/suite/floor and number) §
7. City *
8. State *
9. Postal Code *
10. Country *
12. Telephone Number *
13. Extension §
14. Business Email Address *
D. Attorney or Agent Information (If applicable)
1. Indicate the type of representation for the employer in the filing of this application. *
Complete the remainder of this section if “Attorney” or “Agent” is marked.
Attorney Agent None
2. Attorney or Agent’s Last (family) Name §
3. First (given) Name §
4. Middle Name(s) §
5. Address 1 §
6. Address 2 (apartment/suite/floor and number) §
7. City §
8. State §
9. Postal Code §
10. Country §
11. Province §
12. Telephone Number §
13. Extension §
14. Law Firm/Business Email Address §
15. Law Firm/Business Name §
16. Law Firm/Business FEIN §
FOR ATTORNEY USE ONLY
If “Attorney” is marked in question D.1, complete questions 17 – 19 below.
17. State Bar Number(s) §
18. State of highest state court where attorney is in good standing §
19. Name of the highest state court where attorney is in good standing §
FOR AGENT USE ONLY
If “Agent” is marked in question D.1, complete question 20 below and include the required attachment.
20. A copy of the current agreement or other documentation demonstrating the agent’s authority to represent the
employer is attached to this application. §
Form ETA-9142C FOR DEPARTMENT OF LABOR USE ONLY Page 2 of 5
CW-1 Case Number: __________________ Case Status: __________________ Determination Date: _____________ Validity Period: _____________ to _____________
OMB Approval: 1205-0534
Expiration Date: 10/31/2021
CW-1 Application for Temporary Employment Certification
Form ETA-9142C
U.S. Department of Labor
E. Job Opportunity Information
a. Occupational Classification and PWD
1. SOC Occupational Code *
2. SOC Occupation Title *
3. If “No” is marked to question A.5, enter the PWD case number obtained
from the U.S. Department of Labor for this job opportunity. *
b. Job Offer and Minimum Requirements
1. Job Title *
2. Workers
Needed *
Period of Intended Employment
3. Begin Date: * 4. End Date: *
5. Job Duties – Description of the specific services or labor to be performed. *
(All job duties must be disclosed on this form. The response must begin in the form space. One separate attachment will be accepted to fully complete the
response.)
6. Anticipated days and hours of work per week (an entry is required for each box below) * 7. Hourly work schedule *
a. Total Hours
c. Monday e. Wednesday g. Friday
a. _____ : _____
AM
PM
b. Sunday d. Tuesday f. Thursday h. Saturday
b. _____ : _____
AM
PM
8. Education: minimum U.S. diploma/degree required. *
None High School/GED Associate’s Bachelor’s Master's Doctorate (PhD) Other degree (JD, MD,
etc.)
9. Training: number of months required. *
10. Work Experience: number of months required. *
11. Supervision: does this position supervise
the work of other employees? *
Yes
No
11a. If “Yes” to question 11, enter the number of
employees worker will supervise.§
12. Special Requirements - List specific skills, licenses/certifications, field(s) of training, and requirements of the job. *
Form ETA-9142C FOR DEPARTMENT OF LABOR USE ONLY Page 3 of 5
CW-1 Case Number: __________________ Case Status: __________________ Determination Date: _____________ Validity Period: _____________ to _____________
OMB Approval: 1205-0534
Expiration Date: 10/31/2021
CW-1 Application for Temporary Employment Certification
Form ETA-9142C
U.S. Department of Labor
c. Place of Employment and Wage Information
1. Worksite Address *
2. Worksite Address
§ (apartment/suite/floor and number)
3. City *
4. State *
5. Postal Code *
6. Basic Wage Rate Paid *
From: To:
$ ______ . ____
*
$ ______ . ____
6a. Overtime Wage Rate Paid
§
From: To:
$ ______ . ____
$ ______ . ____
7. Per (Choose only one) *
Hour Week Bi-
Weekly
Month Year Piece Rate
7a. Additional conditions about the wage rate to be paid. §
8. Frequency of Pay. * Daily Weekly Biweekly Other (specify): ________________________
9. Will work be performed at worksite locations other than the one identified above? *
Yes
No
10. If “Yes” is marked in question E.c.9, a completed Appendix B is attached to this application. §
d. Other Material Terms and Conditions of the Job Offer
1. I have read and agree to provide the following terms and conditions with this job offer as fully
Yes
No
explained in Form ETA-9142C – General Instructions and at 20 CFR 655, Subpart E. *
Three-Fourths Guarantee: Workers will be offered employment for a total number of work hours equal to at least three-
fourths of the workdays of the total period that begins with the first workday after the arrival of the worker at the place of
employment or the advertised contractual first date of need, whichever is later, and ends on the expiration date specified
in the work contract or in its extensions, if any.
Transportation and Subsistence: If the worker completes 50 percent of the work contract period, the employer will
provide, reimburse, or advance payment for the worker’s transportation and subsistence from the place of recruitment to
the place of work. Upon completion of the work contract or where the worker is dismissed earlier, the employer will
provide or pay for the worker’s reasonable costs of return transportation and subsistence back home or to the place the
worker originally departed to work, except where the worker will not return due to subsequent employment with another
employer or where the employer has appropriately reported a worker’s voluntary abandonment of employment. The
amount of transportation payment or reimbursement will be equal to the most economical and reasonable common carrier
for the distances involved.
2. Daily Transportation: Workers will be provided with daily transportation to and from the worksite in
Yes N/A
compliance with all applicable Federal and Commonwealth laws and regulations. *
3.
Overtime Available:
Overtime hours will be available to the worker under this job offer and payable
Yes N/A
for every hour worked at the rate disclosed in this application. *
4. On-the-Job Training Available: Workers will be provided with on-the-job training to perform the
Yes N/A
duties assigned. *
5. Employer-Provided Tools and Equipment: Workers will be provided, without charge or deposit
Yes N/A
charge, all tools, supplies, and equipment required to perform the duties assigned. *
6.
Board, Lodging, or Other Facilities:
Workers will be provided with board, lodging, or other
Yes N/A
facilities and/or the employer will assist workers in securing board, lodging, or other facilities. *
7. Deductions from Pay: State all deduction(s) from pay and, if known, the amount(s). *
Form ETA-9142C FOR DEPARTMENT OF LABOR USE ONLY Page 4 of 5
CW-1 Case Number: __________________ Case Status: __________________ Determination Date: _____________ Validity Period: _____________ to _____________
OMB Approval: 1205-0534
Expiration Date: 10/31/2021
CW-1 Application for Temporary Employment Certification
Form ETA-9142C
U.S. Department of Labor
e. Recruitment Information
1. Explain how prospective U.S. applicants may be considered for employment under this job opportunity, including verifiable
methods of contacting the employer, and the days and hours applicants can apply for the job. *
2. Telephone Number to Apply *
3. Email Address to Apply *
4. Website address (URL) to Apply *
F. Declaration of Employer and Attorney/Agent
In accordance with Federal regulations, the employer(s) must attest to 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 C will not be certified by the Department.
1. Please confirm that you have read and agree to all the applicable terms, assurances, and
obligations contained in Appendix C and have attached a signed and dated copy of Appendix C
with this application. *
Yes No
2. Please confirm that the employer-client identified in Appendix A has read and agrees to all the
applicable terms, assurances, and obligations contained in Appendix C and has attached a
separate signed and dated copy of Appendix C with this application. *
Yes No N/A
G. Preparer
Complete this section if the preparer of this application is a person other than the one identified in either Section C (employer point of contact) or Section D (attorney
or agent) of this application.
1. Last (family) Name
§
2. First (given) Name
§
3. Middle Initial
§
4. Law Firm/Business FEIN §
5. Law Firm/Business Name §
6. Law Firm/Business Email Address §
Public Burden Statement (1205-0534)
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 and 50 minutes to complete the form and its appendices, including the
time for reviewing instructions, searching existing data sources, gathering and maintaining the needed data, and completing and reviewing the
collection of information. The burden estimate is as follows: 9142C - 45 minutes, Appendix A - 15 minutes, Appendix B - 20 minutes, Appendix C
- 20 minutes, and recordkeeping - 10 minutes. The obligation to respond to this data collection is required to obtain/retain benefits (Norther
n
M
ariana Islands U.S. Workforce Act of 2018, 48 U.S.C. 1806 et seq.). Please send comments regarding this burden estimate or any ot
her
aspect of this information collection to the U.S. Department of Labor * Employment and Training Administration * Office of Foreign Labor
C
ertification * 200 Constitution Ave., NW * Box PPII 12-200 * Washington, DC * 20210 or by email to ETA.OFLC.Forms@dol.gov
. Please d
o
not send the completed application to this address.
Form ETA-9142C FOR DEPARTMENT OF LABOR USE ONLY Page 5 of 5
CW-1 Case Number: __________________ Case Status: __________________ Determination Date: _____________ Validity Period: _____________ to _____________
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Form ETA-9142C: New employment Renewal of approved employment (Department of Labor)

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Completed 26 January 2021

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