Application To Employ Non-Application To Employ Non-Resident Worker(S) Resident Worker(S) Resident Worker(S) And Employer'S Non- Employer'S Non-Resident Wo Resident Wo Resident Worker Agreement
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1
2
3FEDERATED STATES OF MICRONESIA
DEPARTMENT OF JUSTICE
DIVISION OF IMMIGRATION AND LABOR
Palikir, Pohnpei FM 96941
APPLICATION TO EMPLOY NON
APPLICATION TO EMPLOY NON
APPLICATION TO EMPLOY NON
APPLICATION TO EMPLOY NON- - - - RESIDENT WORKER(S)
RESIDENT WORKER(S)
RESIDENT WORKER(S)
RESIDENT WORKER(S)
AND
AND
AND
AND
EMPLOYER’S NON
EMPLOYER’S NON- - - - RESIDENT WO
EMPLOYER’S NON
EMPLOYER’S NON
RESIDENT WO
RESIDENT WO
RESIDENT WORKER AGREEMENT
RKER AGREEMENT
RKER AGREEMENT
RKER AGREEMENT
IMPORTANT: This application is limited to employment of non-resident workers in one occupational category (job classification) only.
In accordance with the provisions of Title 51, FSM Code, non-resident workers must report to work in the F.S.M. no later than sixty
(60) days after the effective date of the National Government Endorsement (see page 2).
SECTION A
SECTION A- - - - APPLICATION
SECTION A
SECTION A
APPLICATION
APPLICATION
APPLICATION
1. Name of Employer:_________________________
2. Address:_____________________________________
3. Location where alien will work (list each state if more than one):________________________________________________
4. Current Size of Organization: Annual Sales or Income$_________
No. of Resident Workers:_____________________________
No. of Non-Resident Workers:__________________________
Total No. of Employees:_____________________________
5. Foreign Business Permit No._________________________ 6. Government Contract No. (if applicable):__________________
7. State or Municipal Business Permit No.________________________________________________________________
8. Brief non-technical description of the nature of employer’s business or activity:________________________________________
_______________________________________________________________________________________
9. Exact dates you expect to employ alien(s) (Not to exceed one year):
From:________________
To:___________________
10. Job Classification:
10. Job Classification:_____________________
10. Job Classification:
10. Job Classification:
11. No. of openings to be filled:
11. No. of openings to be filled:
11. No. of openings to be filled:
11. No. of openings to be filled:__________________
12. Describe fully the job to be performed:
Duties:___________________________________________________________________________________
_______________________________________________________________________________________
13. Equipment operated:________________________
Working conditions:________________________________
14. State in detail the minimum requirements for worker to perform satisfactorily the job duties described above:
Education and Training:_________________________________________________________________________
Work Experience:____________________________________________________________________________
_______________________________________________________________________________________
Specify any other special requirements:________________________________________________________________
_______________________________________________________________________________________
15. Describe efforts you have made to fill job with a resident worker:________________________________________________
_______________________________________________________________________________________
16. What is the regularly scheduled work week and hours? Days: From________ to________. Hours: From________ to__________
17. Rate of pay:
Regular $_______________
per__________________
Overtime $ ______________
per__________________
18. Additions to basic rate of pay (commissions, price rate, etc.): __________________________________________________
_______________________________________________________________________________________
19. Employee’s salary is subject to the following deductions: Housing:________ Board:________ Transportation:_______ Other:_______
_______________________________________________________________________________
SELECTION B
SELECTION B- - - - HEAL
SELECTION B
SELECTION B
HEAL
HEAL
HEALTH SERVICES LIVING QUARTERS CLEA
TH SERVICES LIVING QUARTERS CLEA
TH SERVICES LIVING QUARTERS CLEARANC
TH SERVICES LIVING QUARTERS CLEA
RANC
RANC
RANCE E E E
When employer’s total number of non-resident workers exceeds twelve (12), this application must be accompanied by a living
quarters inspection clearance issued by the State Director of Health Services. A request for clearance should be directed to the
State Chief Sanitarian who will arrange for a physical inspection of living quarters facilities.
COPY- FSM LABOR
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