O MB Approval: 1205-0134
Expiration Date: XX/XX/XXXX
Non-Criteria Agricultural Clearance Order
Form ETA-790B Addendum B
U.S. Department of Labor
C. Additional Agricultural Business Information
Ag Business 1
1. FEIN (from IRS) * |
2. Legal Business Name * |
|||
3. Trade Name/Doing Business As (DBA), if applicable § |
4. Previous DBA, if applicable § |
5. Previous DBA, if applicable § |
||
6. Address 1 * |
7. Address 2 (suite/floor and number) § |
|||
8. City * |
9. State *
|
10. Postal code * |
Ag Business 2
1. FEIN (from IRS) * |
2. Legal Business Name * |
|||
3. Trade Name/Doing Business As (DBA), if applicable § |
4. Previous DBA, if applicable § |
5. Previous DBA, if applicable § |
||
6. Address 1 * |
7. Address 2 (suite/floor and number) § |
|||
8. City * |
9. State *
|
10. Postal code * |
11. County * |
Ag Business 3
1. FEIN (from IRS) * |
2. Legal Business Name * |
|||
3. Trade Name/Doing Business As (DBA), if applicable § |
4. Previous DBA, if applicable § |
5. Previous DBA, if applicable § |
||
6. Address 1 * |
7. Address 2 (suite/floor and number) § |
|||
8. City * |
9. State *
|
10. Postal code * |
11. County * |
D. Additional Place of Employment Information
1. Place of Employment * |
2. Additional Place of Employment Information and crop and agricultural activity * |
3. Begin Date § |
4. End Date § |
5. Total Workers § |
||
|
|
|
|
|
||
|
||||||
|
|
|||||
|
|
|||||
|
|
|
|
|
||
|
||||||
|
|
|||||
|
|
|||||
|
|
|
|
|
||
|
||||||
c. City* |
d. State * |
|||||
e. Postal Code * |
f. County * |
|||||
|
|
|
|
|
||
|
||||||
c. City * |
d. State * |
|||||
e. Postal Code * |
f. County * |
|||||
|
|
|
|
|
||
|
||||||
c. City * |
d. State * |
|||||
e. Postal Code * |
f. County * |
E. Additional Housing Information
1. Type of Housing * |
2. Physical Location * |
3. Additional Housing Information § |
4. Total Units * |
5. Total Occupancy * |
Employer-provided Rental or public accommodations |
|
|
|
|
Employer-provided Rental or public accommodations |
|
|
|
|
Employer-provided
Rental or public accommodations |
|
|
|
|
Employer-provided Rental or public accommodations |
|
|
|
|
Employer-provided Rental or public accommodations |
|
|
|
|
For Public Burden Statement, see the Instructions for Form ETA-790B.
Form ETA-790B Addendum
FOR STATEWORKFORCE AGENCY USE ONLY
Page B.
Clearance Order Number: _______________________
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | USDOL |
File Modified | 0000-00-00 |
File Created | 2024-07-26 |