Name and title of Employer

Employee’s current visa type (If in U.S.)

Contact information:
Phone 1 Phone 2 Fax  
E-mail address Cell Phone
Best time to reach
Best form of communication Mail    Phone    Fax     E-mail    Cell Phone
 

Present Foreign Address
Street Address / Apartment number / City / State / Zip / Country:


Contact information:
Phone 1 Phone 2 Fax 
E-mail address Cell Phone

Has any immigrant visa petition ever been filed by or on behalf of this person:No   Yes
If 'Yes" please provide all supporting documentation.
 

Detailed non-technical job description for proposed position (include information regarding minimum education, training and experience necessary for proposed position):

Occupational code (if known) of proposed employment

Additional qualifications and skills employee possesses and proficiency in the use of tools, machines or equipment which would help establish requirements for listed occupation:

List employee licenses (professional, journeyman, etc.):

Number of employees this employee will supervise
Beginning and ending dates of intended employment

Location(s) where services will be performed in the United States (if different than Employer’s address).
In the case employee will be working at different locations, submit wages information for both locations:

Wage Source (if known):
SESA
Collective Bargaining Agreement
Other
Year Source Published
 

Per week
2 weeks
Per year
Per month
Overtime
Hourly
Other compensation (explain)

Value per week or per year of other compensation
Salary Offer
Prevailing wage (if known)

Wage Source (if known):
SESA
Collective Bargaining Agreement
Other
Year Source Published
 

If you checked other than “new employment” give the most recent prior petition number for employee (if known):
 

 
*Applications require several types of supporting documentation.  Please provide responses for the following questions and documentation supporting your responses (i.e., articles of incorporation, federal/state tax returns, financial audits):

Tax Identification Number
EIN Number
Social Security # (if petitioner is a sole-proprietor)
Date established (month/day/year)

Nature of Employer’s Business

Current Number of Employees

Number(s) of H-1B Employees

Annual Gross Income

Annual Net Income

If known:  NAICS Code    DOL/ETA Case Number
 

Describe efforts to recruit U.S. workers and the results (specify sources of recruitment by name):


Please provide evidence that employee possesses the education, training, experience, and abilities for the job.

Employer must certify the following conditions of employment:

a.  I have enough funds available to pay the wage or salary offered the alien.

b.  The wage offered equals or exceeds the prevailing wage and I guarantee that, if labor certification is granted, the wage paid to the alien when the alien begins work will equal or exceed the prevailing wage which is applicable at the time the alien begins work.

c.  The wage offered is not based on commissions, bonuses, or other incentives, unless I guarantee a wage paid on a weekly, bi-weekly, or monthly basis.

d.  I will be able to place the alien on the payroll on or before the date of the alien’s proposed entrance into the United States.

e.  The job opportunity does not involve unlawful discrimination by race, creed, national origin, age, sex, religion, handicap, or citizenship.

f.   The job opportunity is not:

1.  Vacant because the former occupant is on strike or is being out in the course of a labor dispute involving a work stoppage.

2.  At issue in a labor dispute involving a work stoppage.

g.  The job opportunity’s terms, conditions and occupational environment are not contrary to Federal, State or local law.

h.  The job opportunity has been and is clearly open to any qualified U.S. worker.
 

Employer must agree to the following statements:

a.  Wages: Pay nonimmigrants at least the local prevailing wage or the employer’s actual wage, whichever is higher, and pay for non-productive time. Offer nonimmigrants benefits on the same basis as U.S. workers.

b.  Working Conditions: Provide working conditions for nonimmigrants which will not adversely affect the working conditions of workers similarly employed.

c.  Strike, Lockout, or Work Stoppage: No strike or lockout in the occupational classification at the place of employment.

d.  Notice: Notice to union or to workers at the place of employment. A copy of this form to H-1B workers.