Attestation by Employers Using Alien U.S. Department of Labor
Crewmembers for Longshore Activities Employment and Training Administration
At Locations in the State of Alaska OMB Approval No. 1205-0309 Exp. 12/31/2016
1. Full Legal Name of Company 5. Name of U.S. Agent
2. Headquarters Address
(No., St., City, State, Zip Code, Country)
6. U.S. Business Address of Agent
(No., St., City, State, Zip Code)
3. Telephone (Area Code and Number)
4. Name of Chief Executive Officer
7. Telephone of Agent (Area Code and Number)
Fax (Area Code and Number)
8. EMPLOYER ATTESTATION (Use attachment if additional space is needed or multiple locations are covered.)
(a) It is anticipated that longshore activities will be performed at the following times and locations in the State of Alaska (check appropriate
box(es) below for each activity of longshore work to be performed):
First Performance of Activity (month/day/year) Location (name of port, city, or other geographical reference point)
_____________________________________ ____________________________________________________
□ (i) Loading cargo □ (ii) Unloading cargo
□ (iii) Operation of cargo-related equipments □ (iv) Handling of mooring lines
• (b) Before using alien crewmen to perform any longshore activity, a bona fide request will be made to the parties to whom notice has been
provided under item 8(e)(ii) and (iii) below, for United States longshore workers who are qualified and available in sufficient numbers to
perform the longshore activity at the particular time and location, except that
:
(i) wherever two or more contract stevedoring companies have signed a joint collective bargaining agreement with a labor organization
described in 8(e)(i) below, the request for longshore workers may be made to only one such contract stevedoring company, and
(ii) 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
.
• (c) All United States longshore workers who are made available in response to the request for dispatch as attested at item 8(b) above and
who are qualified, available in sufficient numbers, and needed to perform the longshore activity at the particular time and location, will be
employed to perform such activity
.
• (d) The use of alien crewmembers in any employ to perform any longshore activity is not intended or designed to influence an election of a
bargaining representative for workers in the State of Alaska
.
• (e) As of this date, notice of this attestation has been provided to (include copies of actual notices):
(i) Labor organizations which have been recognized as exclusive bargaining representatives of United States longshore workers and
which make available or intend to make available longshore workers to the particular location(s) where the longshore work is to be
performed;
(ii) Contract stevedoring companies which employ or intend to employ United States longshore workers at the particular location(s)
where the longshore work is to be performed; and
(iii) Operators of private docks at which workers in my employ will perform any longshore activity.
____________________________________________________________________________________________________________________________
9. DECLARATION OF EMPLOYER: Pursuant to 28 U.S.C. 1746 , I declare under penalty of perjury that the information provided on this form and
accompanying documentation is true and correct. In addition, I declare that I will comply with the Department of Labor regulations governing this program
and, in particular, that I will make this attestation, supporting documentation, and other records, files and documents available to officials of the Department,
upon such official’s request, during any investigation under this attestation or the immigration and Nationality Act.
____________________________________________ ___________________________
Signature of Chief Executive Officer Date
(or such Officer’s U.S Agent or Designee
________________________________________________________________________________________________________
FOR U.S GOVERNMENT AGENCY USE ONLY: By virtue of my signature below, I acknowledge that this program attestation is accepted for filing on
___________(date) and will be valid for the longshore activities at locations in the state of Alaska herein attested to from _____________(beginning date)
through___________ (date twelve months from beginning date).
___________________________________________ ______________________________
Signature of Authorized DOL Official ETA Case No.
Subsequent DOL action: Suspended________________Invalidated_____________Withdrawn_______________
The Department of Labor is not the guarantor of the accuracy, truthfulness or adequacy of an attestation accepted for filing.
___________________________________________________________________________________________________________________________
Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Respondents’ obligations to
reply to these reporting requirements are mandatory. (8 U.S.C. 1101 et seq.) Public reporting burden for this collection of information is estimated to
average 4 hours 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. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to the U.S. Department of Labor, Office of Foreign Labor Certification, 200 Constitution Avenue,
N.W., Room C4312, Washington, D.C. 20210 (Paperwork Reduction Project 1206-0352).
Page 1 of 2 ETA 9033-A (Dec. 1994)
