ETA-9089 Appendix B: Additional Worksite Information

O MB Approval: 1205-0451

Expiration Date: 05/31/2021

Application for Permanent Employment Certification

Form ETA-9089 – Appendix B: Additional Worksite Information

U.S. Department of Labor

ADDITIONAL WORKSITE INFORMATION

1. Additional Worksite 1 §

1. County		2. State/District/Territory
3. MSA/OES Area Code	3a. MSA Name/OES Area Title

2. Additional Worksite 2 §

1. County		2. State/District/Territory
3. MSA/OES Area Code	3a. MSA Name/OES Area Title

3. Additional Worksite 3 §

1. County		2. State/District/Territory
3. MSA/OES Area Code	3a. MSA Name/OES Area Title

4. Additional Worksite 4 §

1. County		2. State/District/Territory
3. MSA/OES Area Code	3a. MSA Name/OES Area Title

5. Additional Worksite 5 §

1. County		2. State/District/Territory
3. MSA/OES Area Code	3a. MSA Name/OES Area Title

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

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

PERM Case Number: ___________________ Case Status: __________________ Determination Date: ______________ Expiration Date: ______________