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pdfOMB Approval: 1205-0451
Expiration Date: 03/31/2018
Application for Permanent Employment Certification
ETA Form 9089
U.S. Department of Labor
Please read and review the filing instructions before completing this form. A copy of the instructions
can be found at http://www.foreignlaborcert.doleta.gov/pdf/9089inst.pdf.
Employing or continuing to employ an alien unauthorized to work in the United States is illegal and may
subject the employer to criminal prosecution, civil money penalties, or both.
A. Refiling Instructions
1. Are you seeking to utilize the filing date from a previously submitted
Application for Alien Employment Certification (ETA 750)?
1-A. If Yes, enter the previous filing date
Yes
No
1-B. Indicate the previous SWA or local office case number OR if not available, specify state w here case w as
originally filed:
. Schedule A or Sheepherder Information
1. Is this application in support of a Schedule A or Sheepherder Occupation?
Yes
If Yes, do NOT send this application to the Department of Labor. All applications in support of Schedule A or
Sheepherder Occupations must be sent directly to the appropriate Department of Homeland Security office.
No
. Em ployer Inform ation (Headquarters or Main Office)
1. Employer’s name
2. Address 1
Address 2
3. City
State/Province
4. Phone number
Country
Postal code
Extension
5. Number of employees
6. Year commenced business
7. FEIN (Federal Employer Identification Number)
8. NAICS code
9- Is the employer a closely held corporation, partnership, or sole proprietorship in w hich
the alien has an ow nership interest, or is there a familial relationship betw een the
ow ners, stockholders, corporate officers, incorporators, or partners, and the alien?
Yes
No
C. Em ployer Contact Inform ation (This section m ust be filled out. This inform ation m ust be different from the
agent or attorney inform ation listed in Section E).
1. Contact’s last name
First name
Middle initial
2. Address 1
Address 2
3. City
4. Phone number
State/Province
Country
Postal code
Extension
5. E-mail address
ETA Form 9089
ETA Case Number:
This Certification is valid from ________________to________________
Page 1 of 15
OMB Approval: 1205-0451
Expiration Date: 03/31/2018
Application for Permanent Employment Certification
ETA Form 9089
U.S. Department of Labor
E. Agent or Attorney Inform ation (If applicable)
1. Agent or attorney’s last name
First name
Middle initial
2. Firm name
3. Firm EIN
4. Phone number
Extension
5. Address 1
Address 2
6. City
State/Province
Country
Postal code
7. E-mail address
F. Prevailing Wage Inform ation (as provided by the State Workforce Agency)
1. Prevailing w age tracking number ((if applicable)
2. SOC/O*NET(OES) code
3. Occupation Title
4. Skill Level
5. Prevailing w age
Per:
$
(Choose only one)
Hour
6. Prevailing w age source (Choose only one)
OES
Week
CBA
Employer Conducted Survey
6-A. If Other is indicated in question 6, specify:
7. Determination date
Bi-Weekly
Month
SCA
DBA
Year
Other
8. Expiration date
9. Area of intended employment
G. Wage Offer Inform ation
1. Offered w age
From:
$
To: (Optional)
Per: (Choose only one)
$
Hour
Week
Bi-Weekly
Month
Year
H. Job Opportunity Inform ation (Where w ork will be performed)
1. Primary w orksite (w here w ork is to be performed) address 1
Address 2
2. City
State
Postal code
3. Job title
4. Education: minimum level required:
None
High School
Bachelor’s
Associate’s
4-A. If Other is indicated in question 4, specify the education required:
Master’s
Doctorate
Other
4-B. Major field of study
ETA Form 9089
ETA Case Number:
This Certification is valid from ________________to________________
Page 2 of 15
OMB Approval: 1205-0451
Expiration Date: 03/31/2018
Application for Permanent Employment Certification
ETA Form 9089
U.S. Department of Labor
5. Is training required in the job opportunity?
Yes
No
5-A. If Yes, number of months of training required:
H. Job Opportunity Information Continued
5-B. Indicate the field of training:
6. Is experience in the job offered required for the job?
6-A. If Yes, number of months experience required:
Yes
No
7. Is there an alternate field of study that is acceptable?
Yes
No
Yes
No
7-A. If Yes, specify the major field of study:
8. Is there an alternate combination of education and experience that is acceptable?
8-A. If Yes, specify the alternate level of education required:
None
High School
Associate’s
Bachelor’s
Master’s
8-B. If Other is indicated in question 8-A, indicate the alternate level of education required:
Doctorate
Other
8-C. If applicable, indicate the number of months experience acceptable in question 8:
9. Is a foreign educational equivalent acceptable?
10. Is experience in an alternate occupation acceptable?
Yes
No
10-A. If Yes, number of months experience in alternate
occupation required:
Yes
No
10-B. Identify the job title of the acceptable alternate occupation:
11. Job duties – If submitting by mail, add attachment if necessary. Job duties description must begin in this space.
12. Are the job opportunity’s requirements normal for the occupation?
If the answer to this question is No, the employer must be prepared to
provide documentation demonstrating that the job requirementsare
supported by business necessity.
13. Is know ledge of a foreign language required to perform the job duties?
If the answer to this question is Yes, the employer must be prepared to
provide documenta tion demonstrating that the language requirements
are supported by business necessity.
ETA Form 9089
ETA Case Number:
This Certification is valid from ________________to________________
Yes
No
Yes
No
Page 3 of 15
OMB Approval: 1205-0451
Expiration Date: 03/31/2018
Application for Permanent Employment Certification
ETA Form 9089
U.S. Department of Labor
14. Specific skills or other requirements – If submitting by mail, add attachement if necessary. Skills description must
begin in this space.
15. Does this application involve a job opportunity that includes a combination of
occupations?
Yes
No
16. Is the position identified in this application being offered to the alien
identified in Section J?
Yes
No
17. Does the job require the alien to live on the employer’s premises?
Yes
No
No
No
Yes
No
2. Is this application for a college or university teacher?
If Yes, com plete questions 2-A and 2-B below .
Yes
No
2-A. Did you select the candidate using a competitive recruitment and
selection process?
2-B. Did you use the basic recruitment process for professional occupations?
Yes
No
Yes
No
18. Is the application for a live-in household domestic service w orker?
18-A. If Yes, have the employer and the alien executed the required employment
contract and has the employer provided a copy of the contract to the alien?
Yes
Yes
NA
I. Recruitm ent Information
a. Occupation Type – All must complete this section.
1.
Is this application for a professional occupation, other than a college or
university teacher? Professional occupations are those for w hich a bachelor’s
degree (or equivalent) is usually required.
b. Special Recruitment and Documentation Procedures for College and University Teachers –
Complete only if the answer to question I.a.2-A is Yes.
3. Date alien selected:
4. Name and date of national professional journal in w hich advertisement w as placed:
5. Specify additional recruitment information in this space. Add an attachment if necessary.
c. Professional /Non-Professional Information – Complete this section unless your answer to question B.1 or
I.a.2-A is YES.
ETA Form 9089
ETA Case Number:
This Certification is valid from ________________to________________
Page 4 of 15
OMB Approval: 1205-0451
Expiration Date: 03/31/2018
Application for Permanent Employment Certification
ETA Form 9089
U.S. Department of Labor
6. Start date for the SWA job order
7. End date for the SWA job order
8. Is there a Sunday edition of the new spaper in the area of intended employment?
No
Yes
9: Name of new spaper (of general circulation) in w hich the first advertisement w as placed:
10. Date of first advertisement identified in question 9:
11. Name of new spaper or professional journal (if applicable) in w hich second advertisement w as placed:
Newspaper
Journal
I.
Recruitment Information Continued
12. Date of second new spaper advertisement or date of publication of journal identified in question 11:
d. Professional /Non-Professional Recruitment Information – Complete if the answer to question H.a.1 is YES or if
the answer to H.a.2-B is YES. For Professional occupations, complete at least 3 of the items; for NonProfessional occupations, complete at least 2 of the items.
13. Dates
From:
15. Dates
From:
17. Dates
From:
19. Dates
From:
21. Dates
From:
advertised at job fair
To:
advertised at employer w eb site
To:
advertised at job search w eb site
To:
advertised at employer referral program
To:
advertised at local or ethnic new spaper
To:
14. Dates of on-campus recruiting
From:
To:
16. Dates of advertised w ith trade or professional organization
From:
To:
18. Dates listed w ith private employment firm
From:
To:
20. Dates of advertised w ith campus placement office
From:
To:
22. Dates of advertised w ith radio or TV ads
From:
To:
e. General Information – All must complete this section.
Yes
No
23. Has the employer received payment of any kind for this submission of thie application?
23-A. If Yes, describe details of the payment including the amount, date and purpose of the payment:
24. Has the bargaining representative for w orkers in the occupation in w hich the alien w ill be employed been
provided w ith notice of this filing at least 30 days but not more than 180 days before the date the application is
filed?
Yes
No
NA
25. If there is no bargaining representative, has a notice of this filing been posted for 10 business days in a
conspicuous location at the place of employment, ending at least 30 days before but not more than 180 days
before the date the application is filed?
Yes
No
NA
26. Has the employer had a layoff in the area of intended employment in the occupation involved in this
application or in a related occupation w ithin the six months immediately preceding the filing of this application?
26-A. If Yes, w ere the laid off U.S. w orkers notified and considered for the job opportunity for w hich certification
is sought?
J. Alien Inform ation (This section m ust be filled out. This inform ation m ust be different from the agent or
attorney inform ation listed in Section E).
1. Alien’s last name
First name
Full middle name
2. Current address 1
ETA Form 9089
ETA Case Number:
This Certification is valid from ________________to________________
Page 5 of 15
Yes
No
Yes
No
NA
OMB Approval: 1205-0451
Expiration Date: 03/31/2018
Application for Permanent Employment Certification
ETA Form 9089
U.S. Department of Labor
Address 2
3. City
State/Province
Country
Postal code
4. Phone number of current residence
5. Country of citizenship
6. Country of birth
7. Alien’s date of birth
8. Class of admission
9. Alien registration number (A#)
10. Alien Admission Number (I-94)
11. Education: Highest level achieved as required by the requested job opportunity:
None
High School
Associate’s
Bachelor’s
Master’s
Doctorate
Other
J. Alien Inform ation Continued
11-A. If Other indicated in question 11, specify
12. Specify major field(s) of study
13. Year relevant education completed
14. Institution w here relevant education specified in question 11 w as received
15. Address 1 of conferring institution
Address 2
16. City
State/Province
Country
Postal code
17. Did the alien complete the training required for the requested job opportunity , as
indicated in question H.5?
Yes
No
NA
18. Does the alien have the experience as required for the requested job
opportunity indicated in question H.6?
Yes
No
NA
19. Does the alien possess the alternate combination of education and experience
as indicated in question H.8?
Yes
No
NA
20. Does the alien have the experience in an alternate occupation specified in
question H.10?
Yes
No
NA
18. Does the alien have the experience as required for the requested job
opportunity indicated in question H.6?
Yes
No
NA
19. Does the alien possess the alternate combination of education and experience
as indicated in question H.8?
Yes
No
NA
Yes
No
NA
Yes
No
NA
Yes
No
20. Does the alien have the experience in an alternate occupation specified in
question H.10?
21. Did the alien gain any of the qualifying experience w ith the employer in a
position substantially comparable to the job opportunity requested?
22. Did the employer pay for any of the alien’s education or training
necessary to satisfy any of the employer’s job requirements for this position?
23. Is the alien currently employed by the petitioning employer?
ETA Form 9089
ETA Case Number:
This Certification is valid from ________________to________________
Page 6 of 15
OMB Approval: 1205-0451
Expiration Date: 03/31/2018
Application for Permanent Employment Certification
ETA Form 9089
U.S. Department of Labor
K. Alien Work Experience
List all jobs the alien has held during the past 3 years . Also list any other experience that qualifies the alien for
the job opportunity for w hich the em ployer is seeking certification.
a. Job 1
1. Employer name
2. Address 1
Address 2
3. City
State/Province
4. Type of business
Country
Postal code
5. Job title
6. Start date
7. End date
8. Number of hours w orked per w eek
K. Alien Work Experience Continued
9. Job details (duties performed, use of tools, machines, equipment, skills, qualifications, certifications, licenses, etc.
Include the phone number of the employer and the name of the alien’s supervisor.)
b. Job 2
1. Employer name
2. Address 1
Address 2
3. City
State/Province
4. Type of business
Country
Postal code
5. Job title
6. Start date
7. End date
8. Number of hours w orked per w eek
K. Alien Work Experience Continued
9. Job details (duties performed, use of tools, machines, equipment, skills, qualifications, certifications, licenses, etc.
Include the phone number of the employer and the name of the alien’s supervisor.)
ETA Form 9089
ETA Case Number:
This Certification is valid from ________________to________________
Page 7 of 15
OMB Approval: 1205-0451
Expiration Date: 03/31/2018
Application for Permanent Employment Certification
ETA Form 9089
U.S. Department of Labor
c. Job 3
1. Employer name
2. Address 1
Address 2
3. City
State/Province
Country
4. Type of business
6. Start date
Postal code
5. Job title
7. End date
8. Number of hours w orked per w eek
9. Job details (duties performed, use of tools, machines, equipment, skills, qualifications, certifications, licenses, etc.
Include the phone number of the employer and the name of the alien’s supervisor.)
L. Alien Declaration
I declare under penalty of perjury that Sections J and K are true and correct. I understand that to knowingly furnish
false information in the preparation of this form and any supplement thereto or to aid, abet, or counsel another to do so is
a federal offense punishable by a fine or imprisonment up to five years or both under 18 U.S.C. §§ 2 and 1001. Other
penalties apply as well to fraud or misuse of ETA immigration documents and to perjury with respect to such documents
under 18 U.S.C. §§ 1546 and 1621.
In addition, I further declare under penalty of perjury that I intend to accept the position offered in Section H of this
application if a labor certification is approved and I am granted a visa or an adjustment of status based on this
application.
1. Alien’s last name
First name
2. Signature
Full middle name
Date signed
Note – The signature and date signed do not have to be filled out when electronically submitting to the Department of Labor for
processing, but must be complete when submitting by mail. If the application is submitted electronically, any resulting certification
MUST be signed immediately upon receipt from DOL before it can be submitted to USCIS for final processing. .
M. Declaration of Preparer
1. Was the application com pleted by the em ployer?
If No, you must complete this section.
Yes
No
I hereby certify tha t I have prepared thisapplication at the direct request of the employer listed in Section C and
that to the best of my knowledge the information contained herein istrue and correct. I understand that to
knowingly furnish false information in the preparation of this form and any supplement thereto or to aid, abet, or counsel
ETA Form 9089
ETA Case Number:
This Certification is valid from ________________to________________
Page 8 of 15
OMB Approval: 1205-0451
Expiration Date: 03/31/2018
Application for Permanent Employment Certification
ETA Form 9089
U.S. Department of Labor
another to do so is a federal offense punishable by a fine, imprisonment up to five years or both under 18 U.S.C. §§ 2 and
1001. Other penalties apply as well to fraud or misuse of ETA immigration documents and to perjury with respect to such
documents under 18 U.S.C. §§ 1546 and 1621.
2. Preparer’s last name
First name
Middle initial
3. Title
4. E-mail address
5. Signature
Date signed
Note – The signature and date signed do not have to be filled out when electronically submitting to the Department of Labor for
processing, but must be complete when submitting by mail. If the application is submitted electronically, any resulting certification
MUST be signed immediately upon receipt from DOL before it can be submitted to USCIS for final processing.
N. Em ployer Declaration
By virtue of my signature below, I HEREBY CERTIFY the following conditions of employment:
1. The offered w age equals or exceeds the prevailing w age and I w ill pay at least the prevailing w age.
2. The w age is not based on commissions, bonuses or incentives, unless I guarantee a w age paid on a w eekly, biw eekly, or monthly basis that equals or exceeds the prevailing w age.
3. I have enough funds available to pay the w age or salary offered the alien.
4. I w ill be able to place the alien on the payroll on or before the date of the alien’s
proposed entrance into the United States.
5. The job opportunity does not involve unlaw ful discrimination by race, creed, color, national origin, age, sex,
religion, handicap, or citizenship.
6. The job opportunity is not:
a. Vacant because the former occupant is on strike or is being locked out in the course of a labor dispute
involving a w ork stoppage; or
b. At issue in a labor dispute involving a w ork stoppage.
7. The job opportunity’s terms, conditions, and occupational environment are not contrary to Federal, state, or local
law .
8. The job opportunity has been and is clearly open to any U.S. w orker.
9. The U.S. w orkers w ho applied for the job opportunity w ere rejected for law ful job-related reasons.
10. The job opportunity is for full-time, permanent employment for an employer other than the alien.
I hereby designate the agent or attorney identified in section E (if any) to represent me for the purpose of labor
certification and, by virtue of my signature in Block 3 below , I take full responsibility for the accuracy of any
representations made by my agent or attorney.
I declare under penalty of perjury that I have read and review ed this application and that to the best of my know ledge
the information contained herein is true and accurate. I understand that to knowingly furnish false information in the
preparation of this form and any supplement thereto or to aid, abet, or counsel another to do so is a federal offense
punishable by a fine or imprisonment up to five years or both under 18 U.S.C. §§ 2 and 1001. Other penalties apply as
well to fraud or misuse of ETA immigration documents and to perjury with respect to such documents under 18 U.S.C.
§§ 1546 and 1621.
1. Last name
First name
Middle initial
2. Title
3. Signature
Date signed
Note – The signature and date signed do not have to be filled out w hen electronically submitting to the Department of
Labor for processing, but must be complete w hen submitting by mail. If the application is submitted electronically, any
resulting certification MUST be signed immediately upon receipt from DOL before it can be submitted to USCIS for final
processing.
ETA Form 9089
ETA Case Number:
This Certification is valid from ________________to________________
Page 9 of 15
OMB Approval: 1205-0451
Expiration Date: 03/31/2018
Application for Permanent Employment Certification
ETA Form 9089
U.S. Department of Labor
O. U.S. Governm ent Agency Use Only
Pursuant to the provisions of Section 212(a)(5)(A) of the Immigration and Nationality Act, as amended, I hereby certify
that there are not sufficient U.S. w orkers available and the employment of the above w ill not adversely affect the w ages
and w orking conditions of w orkers in the U.S. similarly employed.
This Certification is valid from _____________________ to _________________________
______________________________________________
Signature of Certifying Officer
______________________________
Date Signed
______________________________________________
Case Number
______________________________
Filing Date
Paperwork Reduction Act Information Control Number 1205-0451
P. OMB Inform ation
Persons are not required to respond to this collection of information unless it displays a currently valid OMB
control number.
Respondent’s reply to these reporting requirements is required to obtain the benefits of
permanent employment certification (Immigration and Nationality Act, Section 212(a)(5)). Public
reporting burden for this collection of information is estimated to average 2 hours per response,
including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding this burden estimate to the Office of Foreign Labor Certification * U.S.
Department of Labor * 200 Constitution Ave., NW, Box 12-200 Washington, DC * 20210.
Do NOT send the completed application to this address.
Q. Privacy Statem ent Inform ation
In accordance with the Privacy Act of 1974, as amended (5 U.S.C. 552a), you are hereby notified that the
information provided herein is protected under the Privacy Act. The Department of Labor (Department or
DOL) maintains a System of Records titled Employer Application and Attestation File for Permanent and
Temporary Alien Workers (DOL/ETA-7) that includes this record.
Under routine uses for this system of records, case files developed in processing labor certification
applications, labor condition applications, or labor attestations may be released as follows: in connection with
appeals of denials before the DOL Office of Administrative Law Judges and Federal courts, records may be
released to the employers that filed such applications, their representatives, to named alien beneficiaries or
their representatives, and to the DOL Office of Administrative Law Judges and Federal courts; and in
connection with administering and enforcing immigration laws and regulations, records may be released to
such agencies as the DOL Office of Inspector General, Employment Standards Administration, the
Department of Homeland Security, and the Department of State.
Further relevant disclosures may be made in accordance with the Privacy Act and under the following
circumstances: in connection with federal litigation; for law enforcement purposes; to authorized parent
locator persons under Pub. L. 93-647; to an information source or public authority in connection with
personnel, security clearance, procurement, or benefit-related matters; to a contractor or their employees,
grantees or their employees, consultants, or volunteers who have been engaged to assist the agency in the
performance of Federal activities; for Federal debt collection purposes; to the Office of Management and
Budget in connection with its legislative review, coordination, and clearance activities; to a Member of
Congress or their staff in response to an inquiry of the Congressional office made at the written request of the
subject of the record; in connection with records management; and to the news media and the public when a
matter under investigation becomes public knowledge, the Solicitor of Labor determines the disclosure is
necessary to preserve confidence in the integrity of the Department, or the Solicitor of Labor determines that a
legitimate public interest exists in the disclosure of information, unless the Solicitor of Labor determines that
disclosure would constitute an unwarranted invasion of personal privacy.
ETA Form 9089
ETA Case Number:
This Certification is valid from ________________to________________
Page 10 of 15
Addendum
H. 11. Job duties
ETA Form 9089
ETA Cas e Nu mb er:
This Certification is valid from ________________to________________
Page 11 of 15
Addendum
H. 14. Specific Skills or Other Requirements
ETA Form 9089
ETA Cas e Nu mb er:
This Certification is valid from ________________to________________
Page 12 of 15
Addendum
I. 5. Specify additional recruitment information in this space
ETA Form 9089
ETA Cas e Nu mb er:
This Certification is valid from ________________to________________
Page 13 of 15
Addendum
K. 9. Job details
ETA Form 9089
ETA Cas e Nu mb er:
This Certification is valid from ________________to________________
Page 14 of 15
Addendum
K. Alien Work Experience Continued
1. Employer name
2.
Address 1
Address 2
3.
City
4.
Type of business
6. Start date
State/Province
Country
Postal code
5. Job title
7. End date
8. Number of hours w orked per w eek
9. Job details (duties performed, use of tools, machines, equipment, skills, qualifications, certifications, licenses, etc.
Include the phone number of the employer and the name of the alien’s supervisor.)
1.
Employer name
2.
Address 1
Address 2
3. City
State/Province
4. Type of business
6. Start date
Country
Postal code
5. Job title
7. End date
8. Number of hours w orked per w eek
9. Job details (duties performed, use of tools, machines, equipment, skills, qualifications, certifications, licenses, etc.
Include the phone number of the employer and the name of the alien’s supervisor.)
ETA Form 9089
ETA Case Number:
This Certification is valid from ________________to________________
Page 15 of 15
| File Type | application/pdf |
| File Title | ETA Form 9089 |
| File Modified | 2018-04-09 |
| File Created | 2018-03-01 |