Form 750B Form 750B Application for Alien Employment Certification

U.S. DEPARTMENT OF LABOR
EMPLOYMENT AND TRAINING ADMINISTRATION
APPLICATION FOR ALIEN EMPLOYMENT CERTIFICATION
OMB Approval No. 1205-0015 Expires: XX/XX/XXXX
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)

2. Present Address

First name

Middle name

Maiden name

(No., Street, City and Town, State or Province and ZIP code)

Country

3. Type of Visa (If in U.S.)

5. Birthplace (City or Town, State or Province)

Country

6. Present Nationality or
Citizenship (Country)

4. Alien’s Birth date
(Month, Day, Year)

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
a.



b.



City in Foreign Country

Foreign Country

City

State

Alien will apply for a visa abroad at the American
Consulate in
Alien is in the United States and will apply for adjustment 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, Colleges
and Universities Attended (include
trade or vocational training facilities)

Field of
Study

FROM
Month

TO
Year

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
O.T. & C.

(Make no entry in
this section - FOR
Government Agency
USE ONLY)

(Items continued on next page)

ETA 750 Part B (Nov 2007)

OMB Control No. 1205-0015
15. WORK EXPERIENCE

Expires: XX/XX/XXXX

List all jobs held during the last three (3) years. Also, list any other jobs related to the occupation for which the alien is
seeking certification as indicated in Item 9.

a. NAME AND ADDRESS OF EMPLOYER

NAME OF JOB

DATE STARTED
Month

DATE LEFT
Month

Year

KIND OF BUSINESS
Year

DESCRIBE IN DETAIL THE DUTIES PERFORMED, INCLUDING THE USE OF TOOLS, MACHINES OR EQUIPMENT

NO. HOURS PER WEEK

b. NAME AND ADDRESS OF EMPLOYER

NAME OF JOB

DATE STARTED
Month

DATE LEFT
Month

Year

KIND OF BUSINESS
Year

DESCRIBE IN DETAIL THE DUTIES PERFORMED, INCLUDING THE USE OF TOOLS, MACHINES OR EQUIPMENT

NO. HOURS PER WEEK

c. NAME AND ADDRESS OF EMPLOYER

NAME OF JOB

DATE STARTED
Month

DATE LEFT
Month

Year

KIND OF BUSINESS
Year

DESCRIBE IN DETAIL THE DUTIES PERFORMED, INCLUDING THE USE OF TOOLS, MACHINES OR EQUIPMENT

NO. HOURS PER WEEK

16. DECLARATIONS
DECLARATION
OF
ALIEN



Pursuant to 28 U.S.C. 1746, I declare under penalty of perjury the foregoing is true and correct.
DATE

SIGNATURE OF ALIEN

_________________________________________________________________________________________________________________________________________
E-mail address of Alien:
AUTHORIZATION
OF
AGENT OF ALIEN



I hereby designate the agent below to represent me for the purposes of labor certification and I take full
responsibility for accuracy of any representations made by my agent.
DATE

SIGNATURE OF ALIEN

NAME OF AGENT

(Type or print)

ADDRESS OF AGENT

(No., Street, City, State, ZIP code)

__________________________________________________________________________________________
E-mail address of Agent::
OMB No.: 1205-0015 OMB Expiration Date: XX/XX/XXXX. OMB Burden Hours averages 1.8 hours. OMB Burden Statement: These reporting instructions have been approved under the Paperwork
Reduction Act of 1995. Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Obligations to reply are mandatory. (Title 8 U.S.C. §§
1882, 1884, and 1188) Public reporting burden for this collection of information, which is to assist with planning and program management, includes the time to review instructions, search existing data
sources, gather and maintain the data needed, and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to the U.S. Department of Labor, Room 12-200, 200 Constitution Ave. NW, Washington, DC 20210. (Paperwork Reduction Project OMB 1205-0015.)

PRIVACY ACT STATEMENT
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 (DOL) is maintaining a System of Records titled Employer Application and Attestation File for
Permanent and Temporary Alien Workers (DOL /ETA-7).
Case files developed in processing labor certification applications, labor condition applications, or labor attestations, may be released to the
employers which filed such applications, their representatives, and to named alien beneficiaries or their representatives, if requested, to
review Employment and Training Administration (ETA) actions in connection with appeals of denials before the DOL Office of Administrative
Law Judges and federal courts; to participating agencies such as the DOL Office of Inspector General, Employment Standards
Administration. Department of Homeland Security 's U.S., Citizenship and Immigration Services and Bureau of Immigration and Customs
Enforcement, and Department of State in connection with administering and enforcing related immigration laws and regulations; and to the
DOL Office of Administrative Law Judges and Federal Courts in connection with appeals of denials of labor certification requests, labor
condition applications, and labor attestations.
Further disclosures may be made 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 in connection with personnel, procurement, or
benefit-related matters, to a contractor or their employees, consultants, grantees or their employees, or volunteers who have been engaged
to assist the agency in the performance of a contract; for Federal debt collection purposes: the Office of Management and Budget in
connection with its legislative review, coordination, and clearance activities; if a person about whom this record is maintained
submits a written request to a Member of Congress or their staff and that request is forwarded to the Department, we may release the
information to the Member of Congress or Congressional sta ff in response to the inquiry made on behalf of the subject of the record: 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 or integrity of the Department, or the Solicitor of Labor determines that a legitimate public interest exists
in the disclosure of information unless the disclosure would constitute an unwarranted invasion of personal privacy.