Form Eta 9035 - Applicationfor Nonimigrant Workers Page 3
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1
2
3Labor Condition
U.S. Department of Labor
Form ETA 9035
Application for
OMB Approval: 1205-0310
Employment and Training Administration
Nonimmigrant Workers
Expiration Date: 11/30/2008
G. Public Disclosure Information
You must choose one of the two options listed in this Section.
Employer's principal place of business
1. Public disclosure information will be kept at:
Place of employment
H. Declaration of Employer
By signing this form, I, on behalf of the employer, attest that the information and labor condition statements provided are true and
accurate; that I have read the sections E, F, and F-1 of the cover pages (Form ETA 9035CP), and that I agree to comply with the
Labor Condition Statements as set forth in the cover pages and with the Department of Labor regulations (20 CFR part 655,
Subparts H and I). I agree to make this application, supporting documentation, and other records available to officials of the
Department of Labor upon request during any investigation under the Immigration and Nationality Act.
MI
1. First Name of Hiring or Other Designated Official
2. Last Name of Hiring or Other Designated Official
3. Hiring or Other Designated Official Title
5. Date Signed
/
/
4. Signature - Do NOT let signature extend beyond the box
Making fraudulent representations on this Form can lead to civil or criminal action
under 18 U.S.C. 1001, 18 U.S.C. 1546, or other provisions of law.
I. Contact Information
MI
1. Contact First Name
2. Contact Last Name
Extension
3. Contact Phone Number
(
)
-
J. U.S. Government Agency Use Only
By virtue of my signature below, I hereby acknowledge this application certified for
Date Starting _________________________________
and Date Ending _______________________________________
______________________________________________________________
_________________ _________________
Signature and Title of Authorized DOL Official
ETA Case Number
Date
The Department of Labor is not the guarantor of the accuracy, truthfulness, or adequacy of a certified labor condition application.
K. Complaints
Complaints alleging misrepresentation of material facts in the labor condition application and/or failure to comply with the terms of the labor
condition application may be filed with any office of the Wage and Hour Division, U.S. Department of Labor. Complaints alleging failure to
offer employment to an equally or better qualified U.S. worker, or an employer's misrepresentation regarding such offer(s) of employment, may
be filed with: U.S Department of Justice * Office of the Special Counsel for Immigration-Related Unfair Employment Practices* 950
Pennsylvania Ave, NW * Washington, DC * 20530.
If filing the form electronically, the Page Link field will be automatically created for you
Page Link
upon printing. If filing the form manually, please ensure that the Page Link field contains a
Page Link
6 digit number that is repeated on all 3 pages.
3417
Form ETA 9035 - Page 3 of 3
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