ETA-9089 Appendix A: Foreign Worker Information

O MB Approval: 1205-0451

Expiration Date: XX/XX/XXXX

Application for Permanent Employment Certification

Form ETA-9089 – Appendix A: Foreign Worker Information

U.S. Department of Labor

FOREIGN WORKER INFORMATION

1. Foreign Worker Contact Information

1. Foreign Worker’s Last (family) Name *
2. Foreign Worker’s First (given) Name *
3. Foreign Worker’s Middle Name(s) *
4. Address 1 (current) *
5. Address 2 (apartment/suite/floor and number) §
6. City *		7. State *	8. Postal Code *
9. Country *		10. Province §
11. Date of Birth (mm/dd/yyyy) *	12. Class of Admission *	13. Alien Registration Number (A#) (if applicable) *
14. Country of Birth *
15. Country of Citizenship or Nationality *

2. Foreign Worker Education §

1. Educational Attainment Information 1

1. Education: U.S. Diploma/Degree attained relevant to the job opportunity  None  High School/GED  Associate  Bachelor’s  Master's  Doctorate (PhD)  Other Degree (JD, MD, etc.)
1a. If “Other Degree” in question 1, specify the diploma/degree attained
1b. Specify major(s) and/or field(s) of study (may list more than one related major and more than one field)
1c. Name of Institution that issued the degree/diploma
1d. Name of Country of institution identified in question 1c	1e. Month/year attained (mm/yyyy)

2. Educational Attainment Information 2

1. Education: U.S. Diploma/Degree attained relevant to the job opportunity  None  High School/GED  Associate  Bachelor’s  Master's  Doctorate (PhD)  Other Degree (JD, MD, etc.)
1a. If “Other Degree” in question 1, specify the diploma/degree attained
1b. Specify major(s) and/or field(s) of study (may list more than one related major and more than one field)
1c. Name of Institution that issued the degree/diploma
1d. Name of Country of Institution identified in question 1c	1e. Month/year attained (mm/yyyy)

2. Foreign Worker Education (continued)

3. Educational Attainment Information 3

1. Education: U.S. Diploma/Degree attained relevant to the job opportunity  None  High School/GED  Associate  Bachelor’s  Master's  Doctorate (PhD)  Other Degree (JD, MD, etc.)
1a. If “Other Degree” in question 1, specify the diploma/degree attained
1b. Specify major(s) and/or field(s) of study (may list more than one related major and more than one field)
1c. Name of Institution that issued the degree/diploma
1d. Name of Country of Institution identified in question 1c	1e. Month/year attained (mm/yyyy)

4. Educational Attainment Information 4

1. Education: U.S. Diploma/Degree attained relevant to the job opportunity  None  High School/GED  Associate’s  Bachelor’s  Master's  Doctorate (PhD)  Other Degree (JD, MD, etc.)
1a. If “Other Degree” in question 1, specify the diploma/degree attained
1b. Specify major(s) and/or field(s) of study (may list more than one related major and more than one field)
1c. Name of Institution that issued the degree/diploma
1d. Name of Country of Institution identified in question 1c	1e. Month/year attained (mm/yyyy)

5. Educational Attainment Information 5

1. Education: U.S. Diploma/Degree attained relevant to the job opportunity  None  High School/GED  Associate’s  Bachelor’s  Master's  Doctorate (PhD)  Other Degree (JD, MD, etc.)
1a. If “Other Degree” in question 1, specify the diploma/degree attained
1b. Specify major(s) and/or field(s) of study (may list more than one related major and more than one field)
1c. Name of Institution that issued the degree/diploma
1d. Name of Country of Institution identified in question 1c	1e. Month/year attained (mm/yyyy)

3. Foreign Worker Training Qualifications §

1. Training, Certification(s), and/or License(s) Information 1

1. Name of Institution/School/Training provider
1a. Name of training, coursework, experience received
1b. Training/Certifications/licenses attained (if applicable)
1c. Start date of training (mm/yyyy)	1d. End date of training (mm/yyyy)	1e. Month/year awarded (mm/yyyy)

2. Training, Certification(s), and/or License(s) Information 2

1. Name of Institution/School/Training provider
1a. Name of training, coursework, experience received
1b. Training/Certifications/Licenses attained (if applicable)
1c. Start date of training (mm/yyyy)	1d. End date of training (mm/yyyy)	1e. Month/year awarded (mm/yyyy)

3. Training, Certification(s), and/or License(s) Information 3

1. Name of Institution/School/Training provider
1a. Name of training, coursework, experience received
1b. Training/certifications/licenses attained (if applicable)
1c. Start date of training (mm/yyyy)	1d. End date of training (mm/yyyy)	1e. Month/year awarded (mm/yyyy)

3. Foreign Worker Training Qualifications §

1. Skills, Abilities, and Proficiencies 1

1. Name of Employer/Institution/School/Training Provider
1a. Country	1b. State, Territory, or Province
1c. Description of specific skills, abilities, and/or proficiencies the foreign worker possesses or attained, which help establish whether the foreign worker meets the requirements identified for the job opportunity (up to 1,500 characters)

2. Skills, Abilities, and Proficiencies 2

1. Name of Employer/Institution/School/Training Provider
1a. Country	1b. State, Territory, or Province
1c. Description of specific skills, abilities, and/or proficiencies the foreign worker possesses or attained, which help establish whether the foreign worker meets the requirements identified for the job opportunity (up to 1,500 characters)

3. Foreign Worker Work Experience §

1. Work Experience 1

1. Employer Name
1a. Address 1
1b. Address 2
1c. City or Town					1d. Postal Code
1e. Country		1f. State, Territory, or Province
1g. Job Title
1h. Start Date (mm/yyyy)	1i. End Date (mm/yyyy)		1j. Present  Yes  No	1k. Hours Worked Per Week
1l. Job Duties: Specify details of the job (work tasks performed, use of tools/equipment, supervision, etc.) (up to 3,500 characters)

For Public Burden Statement, see the Instructions for Form ETA-9089.

Form ETA-9089 – Appendix A FOR DEPARTMENT OF LABOR USE ONLY Page A.1 of A.5

PERM Case Number: __________________ Case Status: _________________ Determination Date: _____________ Expiration Date: _____________