Rev. 2 (10-05) Employment Development Department – 7000 Franklin Blvd. - #1100 Sacramento CA 95823
INSTRUCTIONS FOR COMPLETING THE PREVAILING WAGE REQUEST FORM
Item 1. Employer Business Name. Enter the full name
used for legal purposes of the business, firm,
organization, or individual who will request labor
certification.
Item 2. Job Site Address. The job site address should
include the street number, city, state, and ZIP code where
the majority of the work will be performed.
Item 3. County of Job Site. Enter the California county
where the majority of the work will be performed.
Item 4. Nature of Business Activity. Enter a brief non-
technical description, i.e., retail trade, manufacturing,
software development, biotechnology, school, financial
institution, hospital, community service organization etc.
Item 5. Check the appropriate box to indicate if the
business has been granted tax exemption as a non–profit
research organization or is a Non-profit institution of
higher education covered under the American
Competitiveness and Workforce Improvement Act.
Item 6. Check the appropriate box to indicate whether
this is a Permanent, Temporary/Seasonal H-2B, or H-1B
Professional case.
Item 7. Worker’s Name. Enter the name or other unique
identifier of the foreign worker for whom this prevailing
wage form is submitted or “multiple” if the determination
will be applied to more than one position.
Item 8. Job Title of Position Offered. Enter the job title
or payroll title of the job being offered.
Item 9. Hours/Week. Show the basic hours of work
required on a weekly basis so that a standard workweek
can be established for the job.
Item 10. Pay and Rate. Enter the basic guaranteed rate
of pay offered for the position, such as $15.00 per hour,
$2,500 per month, or $37,500 per year.
Item 11. Occupational Title of Worker’s Immediate
Supervisor. State the working or functional title of the
foreign worker’s supervisor.
Item 12. Number and Type of Workers Foreign
Worker Will Supervise. If this is a supervisory position,
enter the number and type of workers, e.g. “engineering
staff,” “clerical staff,” “nursing assistants,” etc. the worker
will supervise. If none, enter “0.”
Item 13. Indicate whether or not the wage for the position
is subject to a collective bargaining agreement. If so,
submit sufficient documentation with the prevailing wage
request to identify the parties to the agreement, the period
covered by the agreement, and the negotiated wage
amount corresponding to the requirements for the position
offered.
Item 14. Job Description. The Department of Labor
requires that the description begin
on the form.
Fill in the space provided on the form before continuing on
an attachment. The form will be returned without a wage if
this requirement is not met.
Fully describe the actual duties of the job offered. The job
description must not be copied verbatim from any source.
Actual duties of the job offered are necessary to
appropriately classify the job and determine the correct
prevailing wage.
The job will be analyzed and categorized based on the
employer’s job description. Enough information must be
given so that an analyst can determine the occupational
category and the skill level within that category. Work
tasks, work activities, equipment used, work environment,
working conditions, complexity of the job duties, level of
judgment and understanding required to perform the job,
amount and nature of supervision received, and
supervisory responsibilities are the elements considered in
defining the job's occupational category, skill level and,
eventually, prevailing wage rate for the labor market area.
For jobs requiring supervisory duties, describe the activities
the worker will supervise, the extent and authority to hire,
fire, train, schedule, and evaluate. If applicable, quantify
the amount of time the supervisor will spend performing
work duties similar to the workers supervised.
Item 15. Indicate whether or not a college degree is
required and state the type of degree (e.g. AA, BS, MS,
PhD, Etc.) and field of study.
Item 16. Indicate whether or not experience in the job is
required and state the minimum amount of experience
required in years and/or months. Do not describe
alternative or ranges of requirements.
Item 17. Indicate whether or not specific training is
required and state the type and amount of training in years
and/or months
Item 18. Indicate whether or not a license is required for
the position and state the type of license required.
Item 19. Describe any special requirements for a worker
to satisfactorily perform the duties described.
Item 20. Attorney or Agent Name. Enter the name of
the employer’s attorney or agent if represented and the
name and the telephone number of the person who should
be contacted if questions arise. Enter the FAX number to
which the completed wage determination should be sent.
SUBMIT THE COMPLETED REQUEST BY FAX TO:
(916) 262-2500
