Appendix B Tracked

OMB Approval: 1205-0509
Expiration Date: 05/31/2022

H-2B Application for Temporary Employment Certification
Form ETA 9142B – Appendix B
U.S. Department of Labor

For Use in Filing Applications Under the H-2B Non-Agricultural Program ONLY1
A.

Attorney or Agent Declaration

I hereby declare under penalty of perjury that I am an attorney for the employer, or that I am an employee of, or hired by, the employer listed in
Section C of the Form ETA-9142B, and that I have been designated by that employer in accordance with 20 CFR 655.8 to act on its behalf in
connection with this application, as evidenced by the attached agency agreement.
I HEREBY CERTIFY that I have provided to the employer the Form ETA-9142B and all supporting documentation for review and to the best of
my knowledge the information contained herein is true and accurate, including the employer’s declaration regarding activities I have undertaken
on the employer’s behalf in connection with this application. I understand that to knowingly and/or willfully furnish materially false information in
the preparation of this form and any supplement hereto or to aid, abet, or counsel another to do so is a federal offense punishable by fines,
imprisonment, or both (18 U.S.C. 2, 1001, 1546, 1621).

1. Attorney or Agent’s Last (family) Name *

2. First (given) Name *

3. Middle Initial §

4. Firm/Business Name *
5. Signature *

B.

6. Date Signed *

Employer Declaration

By virtue of my initials and signature below, I HEREBY CERTIFY my knowledge of and compliance with the following conditions of employment
applicable to H-2B workers and/or U.S. workers who are hired during the recruitment period for positions covered by this application, including
any approved extension thereof:
Initials
1. The job opportunity is a bona fide, full-time temporary position (of at least 35 hours per workweek), the qualifications and
requirements for which are consistent with the normal and accepted qualifications and requirements imposed by non-H-2B
employers in the same or comparable occupations and area of intended employment. The employer has listed all qualifications
and requirements in the job order.
2. There is no strike or lockout at any of the employer’s worksites within the area of intended employment for which the employer
is requesting an H-2B certification.
3. The job opportunity was/is open to any qualified U.S. worker until 21 days before the date of need regardless of race, color,
national origin, age, sex, religion, disability, or citizenship. U.S. workers who apply for the job will be hired, unless the employer
has a lawful, job-related reason(s) for the rejection, and the employer will retain records of all rejections.
4. The employer has not/will not offer terms, wages, and working conditions to U.S workers that are less favorable than those
offered or will be offered to H-2B workers or impose restrictions or obligations on U.S. workers that are not imposed on H-2B
workers. This does not relieve the employer from providing H-2B workers with at least the minimum benefits, wages, and
working conditions that must be offered to U.S. workers under 20 CFR 655.18, except for those required by 20 CFR
655.18(b)(17).
5. The offered wage equals or exceeds the highest of the applicable Federal, State, or local minimum wage, or the prevailing
The Department of Labor Appropriations Act, 2016, Division H, Title I of Public Law 114-113 (“2016 DOL Appropriations Act”), prohibited the Department of
Labor (“Department”) from using any funds to enforce the definition of corresponding employment found in 20 CFR 655.5 or the three-fourths guarantee rule
definition found in 20 CFR 655.20, or any reference thereto. See Sec. 113. This appropriations rider has been included in the continuing resolutions that
have passed throughout FY 2017 and FY 2018, as well as in the Department of Labor Appropriations Act, 2018, Division H, Title I of Public Law 115-141
(“2018 DOL Appropriations Act”). Therefore, in order to comply, the Department has removed references to these provisions from the Form ETA-9142B –
Appendix B.
However, the 2016 DOL Appropriations Act, continuing resolutions, and 2018 DOL Appropriations Act did not vacate these regulatory
provisions, and they remain in effect, thus imposing a legal duty on H-2B employers, even though the Department will not use any funds to enforce them
until such time as the appropriations rider may be lifted.
The Department of Labor Appropriations Act, 2016, Division H, Title I of Public Law 114-113 (“2016 DOL Appropriations Act”), prohibited the
Department of Labor (“Department”) from using any funds to enforce the definition of corresponding employment found in 20 CFR 655.5 or the threefourths guarantee rule definition found in 20 CFR 655.20, or any reference thereto. See Sec. 113. This appropriations rider has been included in the
continuing resolutions that have passed throughout FY 2017, 2018, 2019, 2020, 2021 as well as in the Department of Labor Appropriations Act,
2022, Division H, Title I of Public Law 117-103 ("2022 DOL Appropriations Act"). Therefore, in order to comply, the Department has removed
references to these provisions from the Form 9142B - Appendix B. However, the aforementioned appropriations acts and continuing resolutions did
not vacate these regulatory provisions, and they remain in effect, thus imposing a legal duty on H-2B employers, even though the Department will
not use any funds to enforce them until such time as the appropriations rider may be lifted.
1

Form ETA-9142B – Appendix B

Page B.1 of B.3

OMB Approval: 1205-0509
Expiration Date: 05/31/2022

H-2B Application for Temporary Employment Certification
Form ETA 9142B – Appendix B
U.S. Department of Labor
wage determination for the occupation that is issued by the Department to the employer, as reflected on the employer’s
approved Application for Temporary Employment Certification, for the time period the work is performed. If, after the issuance
of a prevailing wage determination, the Department issues a new or revised prevailing wage determination that is assigned to
the employer’s application or certified period of employment, the employer must offer a wage that equals or exceeds the highest
of the new prevailing wage or the applicable Federal, State, or local minimum wage, unless notified otherwise by the
Department. The employer will pay at least the offered wage, free and clear, either in cash or in a negotiable instrument
payable at par, during the entire period of this application. The employer must use a single workweek as its standard for
computing wages due.
6.

The offered wage is not based on commissions, bonuses or other incentives, unless the employer guarantees a wage earned
every workweek that equals or exceeds the offered wage. The employer guarantees to supplement a piece rate wage if at the
end of the workweek, the piece rate does not result in average hourly piece rate earnings during the workweek at least equal to
the offered wage.

7.

During the period of employment that is the subject of this application, the employer will comply with applicable Federal, State
and local employment-related laws and regulations, including, but not limited to, employment-related health and safety laws, 20
CFR 655, Subpart A, 29 CFR 503, and all applicable provisions of the Fair Labor Standards Act, 29 U.S.C. 201 et seq. In
addition, the employer and its agents and attorneys are prohibited from holding or confiscating workers’ passports, visas, or
other immigration documents pursuant to 18 U.S.C. 1592(a).

8.

The employer has not laid off and will not lay off any similarly employed U.S. worker in the occupation and area of intended
employment within the period beginning 120 days before the date of need through the end of the period of certification, unless
the layoff is for lawful, job-related reasons and all H-2B workers are laid off first.

9.

The employer and its agents, attorneys, and/or employees have not sought or received, and will not seek to receive, payment
of any kind from the worker for any activity related to obtaining certification or employment, including, but not limited to, payment
of the employer’s attorney or agent fees, application or petition fees, or recruitment costs. Payment includes, but is not limited
to, monetary payments, wage concessions (including deductions from wages, salary, or benefits), kickbacks, bribes, tributes, in
kind payments, and free labor.

10. Upon the separation from employment of any H-2B or U.S. worker(s) employed under this application, if such separation
occurs prior to the end date of the employment specified in this application, the employer will notify the Department in writing of
the separation from employment not later than two work days after such separation is discovered by the employer. The
employer will also notify DHS in writing (or any other manner specified by DHS) of such separation of an H-2B worker.
11. The employer will not place any H-2B workers employed pursuant to this application outside the area of intended employment
or in a job classification not listed on the approved application unless the employer has obtained a new approved Form ETA9142B.
12. The employer has accurately represented its temporary need, as defined in 8 CFR 214.2(h)(6)(ii)(B), including the number of
workers requested and dates of employment, on the Form ETA-9142B, job order, or an H-2B Registration, as applicable, and
been granted the H-2B Registration, when applicable.
13. The employer will make all deductions from workers’ paychecks required by law and only those additional authorized and
reasonable deductions disclosed in the job order. Deductions not disclosed will be prohibited. Reasonableness of authorized
deductions is determined under the principles stated in 29 CFR 531. The wage payment requirement in conditions 5 and 6 of
this Declaration will not be met where unauthorized or unreasonable deductions, deposits, rebates, or refunds reduce the wage
payment below the offered wage or where the worker “kicks back” any part of the wages to the employer or another person for
the employer’s benefit.
14. The employer has specified in the job order any applicable minimum productivity standard which the workers must meet in
order to retain the job. With respect to any applicable productivity standard, the employer is able to demonstrate that such
standard is normal and usual for non-H-2B employers for the same occupation in the area of intended employment.
15. If, before the expiration date specified in the job order, the services of a worker are no longer required for reasons beyond
control of the employer due to fire, weather, or other Act of God, or similar unforeseeable man-made catastrophic event,
employer may terminate the job order with written approval of the Certifying Officer, and will make efforts to transfer
workers to comparable employment, or if transfer is not effected, provide return transportation for the worker as specified in
regulations.

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16. The employer will keep a record of workers’ earnings and provide the workers with earnings statements as required by 20 CFR
655.20(i) on or before each payday, which must be at least every two weeks or according to the prevailing practice in the area of
intended employment, whichever is more frequent.
17. The employer has disclosed how it will provide transportation and subsistence costs in the job order. The employer will either
advance all visa, visa-related, border crossing, subsistence, and transportation expenses to workers traveling to the employer’s
worksite from the workers’ place of recruitment, pay for them directly, or reimburse such expenses, other than travel and
subsistence, in the first workweek and reimburse the remainder of the expenses no later than the time workers complete 50
percent of the period covered by the job order. (Advancement of transportation and subsistence costs to U.S. workers
employed under this application is required when it is the prevailing practice of non H-2B employers in the occupation in the
area of intended employment or when the employer extends such benefits to similarly situated H-2B workers.) Provided that
workers work until the end of the certified period of employment or are dismissed from employment for any reason before the
end of that period, the employer will pay for such workers’ return transportation to the place of recruitment and daily
subsistence if the workers have no immediate subsequent H-2B employment. All employer-provided transportation must
comply with all applicable Federal, State, and local laws and regulations.
Form ETA-9142B – Appendix B

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OMB Approval: 1205-0509
Expiration Date: 05/31/2022

H-2B Application for Temporary Employment Certification
Form ETA 9142B – Appendix B
U.S. Department of Labor
18. The employer will provide to workers, without charge or deposit, all tools, supplies, and equipment required to perform the
duties assigned.
19. The employer will provide a copy of the job order to all H-2B workers no later than when the worker applies for a visa if located
abroad, no later than the time of the job offer by the subsequent H-2B employer if the H-2B worker is changing employment from
one H-2B employer to a subsequent H-2B employer, and to U.S. workers employed under this application no later than on the
day work commences. The disclosure must be in a language understood by the workers, as necessary or reasonable.
20. The employer has posted a Department-provided poster detailing H-2B and U.S. workers’ rights and protections in a
conspicuous location at the place of employment. The employer will request and post additional posters in languages common
to a significant portion of the workers if they are not fluent in English.
21. The employer has not and will not (and has not and will not cause another person to) intimidate, threaten, restrain, coerce,
blacklist, discharge, or in any other manner discriminate against any person who, with respect to 8 U.S.C. 1184(c), 20 CFR 655,
Subpart A, 29 CFR 503, or any other Department regulation promulgated thereunder, has filed a complaint; instituted or caused
to be instituted any proceeding; testified or is about to testify; consulted with a worker’s center, community organization, labor
union, legal assistance program, or attorney; or exercised or asserted on behalf of himself/herself or others any right or
protection.
22. The employer has and will contractually forbid in writing any agent or recruiter (or any agent or employee of such agent or
recruiter) whom the employer engages, directly or indirectly, in international recruitment of H-2B workers to seek or receive
payments or other compensation from prospective workers. The employer and its attorney and/or agent have provided with
this application to the Department a copy of all agreements with any agent or recruiter whom it engages or plans to engage in
the international recruitment of H-2B workers, as well as the identity and location of all persons or entities hired by or working
for the agent or recruiter, and any of their agents or employees, to recruit prospective foreign workers for the H-2B job
opportunities offered by the employer.
23. The employer will conduct all required recruitment activities pursuant to 20 CFR 655.40 through 655.46 including but not limited
to: additional recruitment if required by the Certifying Officer and contacting all of its former U.S. workers employed in the
occupation at the place of employment during the previous year, disclosing the terms of the job order, and soliciting their return,
unless they were dismissed for cause or abandoned the worksite.
24. The employer has and will continue to cooperate with the SWA by accepting referrals and will hire all qualified and eligible U.S.
workers who apply for the job opportunity until 21 days before the date of need.
25. The employer will cooperate with any agent or employee of the Secretary of Labor who is exercising or attempting to exercise
the Department’s authority pursuant to 8 U.S.C. 1184(c), including investigations as described in 29 CFR 503.25.
26. The employer will retain all documents pertaining to this application and registration, the recruitment-related documents, the
payroll records, and related documents for three years as required by the regulations at 20 CFR 655.56 and 29 CFR 503.17.
I hereby designate the agent or attorney identified in Section E (if any) of the Form ETA-9142B to represent me for the purpose of labor
certification and, by virtue of my signature in Block 5 below, I take full responsibility for the accuracy of any representations made by my agent
or attorney on every page of the Form ETA-9142B and documentation supporting this application.
I declare under penalty of perjury that I have read and reviewed this application, including every page of the Form ETA-9142B and supporting
documentation, and that to the best of my knowledge the information contained therein is true and accurate. I understand that to knowingly
and/or willfully furnish materially 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 fines, imprisonment, or both (18 U.S.C. 2, 1001, 1546, 1621).

1. Last (family) Name *

2. First (given) Name *

3. Middle Initial §

4. Title *

5. Signature *

6. Date Signed *

For public burden statement information, please see Form ETA-9142B General Instructions.
Public Burden Statement (1205-0509)
Persons are not required to respond to this collection of information unless it displays a currently valid OMB control
number. Public reporting burden for this collection of information is estimated to average 2 hours and 10 minutes to
complete the form and its appendices, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the needed data, and completing and reviewing the collection of information. The burden
estimate is as follows: 9142B- 55 minutes, Appendix A- 15 minutes, Appendix B- 15 minutes, Appendix C- 20 minutes,
Appendix D- 10 minutes, and recordkeeping- 15 minutes. The obligation to respond to this data collection is required to
obtain/retain benefits (Immigration and Nationality Act, 8 U.S.C. 1101 et seq.). Please send comments regarding this
Form ETA-9142B – Appendix B

Page B.3 of B.3

OMB Approval: 1205-0509
Expiration Date: 05/31/2022

H-2B Application for Temporary Employment Certification
Form ETA 9142B – Appendix B
U.S. Department of Labor
burden estimate or any other aspect of this information collection to the U.S. Department of Labor * Employment and
Training Administration * Office of Foreign Labor Certification * 200 Constitution Ave., NW * Box PPII 12-200 * Washington,
DC * 20210 or by email to ETA.OFLC.Forms@dol.gov. Please do not send the completed application to this address.

Form ETA-9142B – Appendix B

Page B.4 of B.3