U.S. DEPARTMENT OF LABOR
EMPLOYMENT AND TRAINING ADMINISTRATION
APPLICATION FOR ALIEN EMPLOYMENT CERTIFICATION
OMB Approval No. 1205-0015 Expires: 06/30/2017
PART B. STATEMENT OF QUALIFICATIONS OF ALIEN
FOR ADVICE CONCERNING REQUIREMENTS FOR ALIEN EMPLOYMENT CERTIFICATION: If the alien is in the U.S., contact nearest office of
the United States Citizenship and Immigration Service. If the alien is outside the U.S., contact nearest U.S. Consulate.
IMPORTANT: READ ATTACHED INSTRUCTIONS BEFORE COMPLETING THIS FORM.
Print legibly in ink or use a typewriter. If you need more space to fully answer any questions on this form, use a separate sheet. Identify
each answer with the number of the corresponding question. Sign and date each sheet.
1. Name of Alien (Family name in capital letters) First name Middle name Maiden name
2. Present Address (No., Street, City and Town, State or Province and ZIP code) Country
3. Type of Visa (If in U.S.)
4. Alien’s Birth date
(Month, Day, Year)
5. Birthplace (City or Town, State or Province) Country 6. Present Nationality or
Citizenship (Country)
7. Address in the United States Where Alien Will Reside
8. Name and Address of Prospective Employer if Alien has job offer in U.S.
9. Occupation in which
Alien is Seeking Work
10. “X” the appropriate box below and furnish the information required for the box marked
City in Foreign Country Foreign Country
a. Alien will apply for a visa abroad at the American
Consulate in
City State
b. Alien is in the United States and will apply for adjust-
ment of status to that of a lawful permanent resident
in the office of the United States Citizenship and Immigration
Service at
11. Names and Addresses of Schools, Col-
Leges and Universities Attended (include
trade or vocational training facilities)
Field of
Study
FROM
Month Year
TO
Month Year
Degrees or Certificates
Received
SPECIAL QUALIFICATIONS AND SKILLS
12. Additional Qualifications and Skills Alien Possesses and Proficiency in the use of Tools, Machines or Equipment Which Would Help Establish if
Alien Meets Requirements for Occupation in Item 9.
13. List Licenses (Professional, journeymen, etc.)
14. List Documents Attached Which are Submitted as Evidence that Alien Possesses the Education, Training, Experience, and Abilities Represented
Endorsements DATE REC. DOL
(Make no entry in
this section - FOR
Government Agency
USE ONLY)
O.T. & C.
(Items continued on next page) ETA 750 Part B (Nov 2007)