Prevailing Wage Request Form - H-1b Nonimmigrants printable pdf download

Please Return to:

Please Check One:

COMMONWEALTH OF VIRGINIA

Virginia Employment Commission

Economic Information Services

____ H-1B Professional

VIRGINIA EMPLOYMENT COMMISSION

Prevailing Wage Unit

703 E. Main Street

P. O. Box 1358

____ F-1 Student

Richmond, Virginia 23219

Richmond, VA 23218-1358

PREVAILING WAGE REQUEST FORM

(804) 786-9948

H-1B NONIMMIGRANTS

FAX (804) 786-2976

If job is unionized and covered by a negotiated wage, use the negotiated wage and do not complete this Prevailing Wage Request Form.

1. Name of Employer

____________________________________________________________________________________________________

2. Address Where Alien Will Work (Including City (County) and ZIP) ________________________________________________________________

3. Nature of Employer's Business Activity

4. Title of Job Being Filled

5. Title of Alien's Immediate

6. Basic Hours Per Week

(SIC code, if known)

(DOT code, if known)

Supervisor

7. Basic Rate of Pay Offered

Per

8. Describe Fully the Job Duties to be Performed (Attach an additional sheet if necessary)

9. Working Conditions that Affect the Rate of Pay

10. State in detail the MINIMUM Qualifications (EDUCATION, include DEGREE) needed to perform the job duties described in Item 8.

Please check one:

_____ Level I

_____ Level II

See instructions under Item 10 for definition of LEVEL I and LEVEL II.

11. Name of Requestor ___________________________________________ Telephone (

) _________________ FAX (

) ________________

Address (Number, Street, City or Town, State, ZIP Code) __________________________________________________________________________

DEPARTMENTAL ACTION TO PROVIDE A PREVAILING WAGE DETERMINATION

Request Number _______________ Date Received

____ It is determined that your offered rate of pay:

DOT Title ____________________________________________

DOT Code ___ ____ ___ ⋅ ___ ____ ___ - ___ ____ ___

____ meets the prevailing wage.

____ does not meet the prevailing wage.

OES Code ____ ____ ____ ____ ____

Skill Level ________________________________________

____ The prevailing wage for the job described above is ____________________ per ________. Source _____________________________________

***THIS PREVAILING WAGE IS VALID FOR FILING APPLICATIONS AND ATTESTATIONS FOR 90 DAYS FROM THE DATE OF THIS

WAGE DETERMINATION.

Agency Official ___________________________________________________________________________ Date __________________________

Prevailing Wage Request Form - H-1b Nonimmigrants

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