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Case Number

Case Status

A. Employment-Based Nonimmigrant Visa Information

1. Indicate the type of visa classification supported by this application
    (Write classification symbol):

B. Temporary Need Information

1. Job Title

2. SOC (ONET/OES) code

3. SOC (ONET/OES) occupation title

4. Is this a full-time position?

Period of Intended Employment

 

5. Begin Date (mm/dd/yyyy)

6. End Date (mm/dd/yyyy)

7. Worker positions needed/basis for the visa classification supported by this application

 

Total Worker Positions Being Requested for Certification

C. Employer Information

1. Legal business name

2. Trade name/Doing Business As (DBA),
    if applicable

3. Address 1

4. Address 2

5. City

6. State

7. Postal code

8. Country

 

9. Province

 

10. Telephone number

11. Extension

 

12. Federal Employer Identification Number (FEIN from IRS)

redacted field

13. NAICS code (must be at least 4-digits)

D. Employer Point of Contact Information

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

2. First (given) name

3. Middle name(s)

4. Contact's job title

5. Address 1

6. Address 2

7. City

8. State

9. Postal code

10. Country

 

11. Province

 

12. Telephone number

13. Extension

 

14. E-Mail address

E. Attorney or Agent Information (If applicable)

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

3. First (given) name

4. Middle name(s)

5. Address 1

6. Address 2

7. City

8. State

9. Postal code

10. Country

11. Province

12. Telephone number

13. Extension

14. E-Mail address

15. Law firm/Business name

16. Law firm/Business FEIN

redacted field

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)

F. Rate of Pay

1. Wage Rate (Required)

From:   $ To:   $

2. Per: (Choose only one)

G. Employment and Prevailing Wage Information

a. Place of Employment 1

1. Address 1

2. Address 2

3. City

4. County

5. State/District/Territory

6. Postal code

Prevailing Wage Information (corresponding to the place of employment location listed above)

7. Agency which issued prevailing wage

7a. Prevailing wage tracking number (if applicable)

8. Wage level
9. Prevailing wage

$

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

 

H. Employer Labor Condition Statements

I. Additional Employer Labor Condition Statements - H-1B Employers ONLY

a. Subsection 1

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?

  • not checkedYes
  • not checkedNo
  • checkedN/A

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.

b. Subsection 2

  • 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.

  • not checkedYes
  • not checkedNo

J. Public Disclosure Information

K. Declaration of Employer

1. Last (family) name of hiring
    or designated official

2. First (given) name of hiring
    or designated official

3. Middle initial

 

4. Hiring or designated official title

5. Signature

6. Date signed

 

L. LCA Preparer

1. Last (family) name

2. First (given) name

3. Middle initial

 

4. Firm/Business name

5. E-Mail address

M. U.S. Government Agency Use (ONLY)

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)

Case Number

Case Status


The Department of Labor is not the guarantor of the accuracy, truthfulness, or adequacy of a certified LCA.


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