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1. Indicate the type of visa classification supported by this application (Write classification symbol):
3. SOC (ONET/OES) occupation title
4. Is this a full-time position?
Period of Intended Employment
5. Begin Date (mm/dd/yyyy)
7. Worker positions needed/basis for the visa classification supported by this application
Total Worker Positions Being Requested for Certification
2. Trade name/Doing Business As (DBA), if applicable
12. Federal Employer Identification Number (FEIN from IRS)
13. NAICS code (must be at least 4-digits)
Important Note: 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 E, unless the attorney is an employee of the employer.
1. Contact's last (family) name
1. Is the employer represented by an attorney or agent in the filing of this application? If "Yes", complete the remainder of Section E below.
2. Attorney or Agent's last (family) name
15. Law firm/Business name
16. Law firm/Business FEIN
17. State Bar number (only if attorney)
18. State of highest court where attorney is in good standing (only if attorney)
19. Name of the highest court where attorney is in good standing (only if attorney)
1. Wage Rate (Required)
From: $
To: $
2. Per: (Choose only one)
5. State/District/Territory
7. Agency which issued prevailing wage
7a. Prevailing wage tracking number (if applicable)
8. Wage level
10. Per: (Choose only one)
11. Prevailing wage source (Choose only one)
11a. Year source published
11b. If "OES", and SWA/NPC did not issue prevailing wage OR "Other" in question 11, specify source
1. Is the employer H-1B dependent?
2. Is the employer a willful violator?
3. If "Yes" is marked in questions I.1 and/or I.2, you must answer "Yes" or "No" regarding whether the
employer will use this application ONLY to support H-1B petitions or extensions of status for exempt H-1B
nonimmigrants?
If you marked "Yes" to questions I.1 and/or I.2 and "No" to question I.3, you MUST read Section I - Subsection 2 of the Labor
Condition Application - General Instructions Form ETA 9035CP under the heading "Additional Employer Labor Condition
Statements" and indicate your agreement to all three (3) additional statements summarized below.
- Displacement: Non-displacement of the U.S. workers in the employer's workforce
- Secondary Displacement: Non-displacement of U.S. workers in another employer's workforce; and
- Recruitment and Hiring: Recruitment of U.S. workers and hiring of U.S. workers applicant(s) who are equally or better qualified than the H-1B nonimmigrant(s).
4. I have read and agree to Additional Employer Labor Condition Statements A, B, and C above and as fully explained in Section I - Subsections 1 and 2 of the Labor Condition Application - General Instructions Form ETA 9035CP.
- Yes
- No
1. Last (family) name of hiring or designated official
2. First (given) name of hiring or designated official
4. Hiring or designated official title
By virtue of the signature below, the Department of Labor hereby acknowledges the following:
This certification is valid
From
To
Department of Labor, Office of Foreign Labor Certification
Determination Date (date signed)
The Department of Labor is not the guarantor of the accuracy, truthfulness, or adequacy of a certified LCA.
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