Prevailing Wage Request Form
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1Department of Workforce Solutions
Select an application type:
STATE OF NEW MEXICO
H-1B
Foreign Labor Certification
H-1B1
PREVAILING WAGE REQUEST FORM
Phone (505) 841-8643
H-2B
FAX (505) 841-9007
E-3
PERM
1. Employer/Business Name
2. Employer/Business Address
3. Job Site Address (If different from Item 2)
4. Nature of Business Activity
5.
Nonprofit or Governmental Research Organization (Attach IRS Tax
Exemption Evidence)
Institution of Higher Education or Related/Affiliated Nonprofit Entity
6. Worker’s Name (Optional if H-1B)
7. Job Title
8. Hours/Week
9. Pay and Rate
10. Occupational Title of Alien’s Immediate
11. Number and Type of Workers Foreign
12. Is wage subject to a union agreement?
Supervisor
Worker Will Supervise (If None, Enter
Yes (Attach evidence of contract
“0.”)
period and negotiated wage rate.)
No
13. Job Description. Fully describe the duties of the job offered. The description must begin in this space.
14. College Degree Required?
Yes
No
15. Experience Required?
Yes
No
16. Training Required?
Yes
No
If yes, specify type and major field of study.
If yes, state the number of years/months.
If yes, state type and years/months.
17. License(s) Required?
Yes
No
18. Other Special Requirements
If yes, specify type(s).
Date of Request
Requestor’s Name and Title
Name of Requestor’s Organization
Requestor’s Business Address
Phone Number
Fax Number
PREVAILING WAGE DETERMINATION
(State Workforce Agency Use Only)
Prevailing Wage Tracking Number
SOC/O*NET (OES) Code
Occupational Title
Skill Level
Prevailing Wage
Prevailing Wage Source
$
per
Hour
Year
OES All Industries
OES EDC
Employer Conducted Survey
DBA
SCA
Other
Other Wage Source Used
Determination Date
Determination Valid Through
Wage Analyst Signature and Printed Name
Telephone Number
NOTES: For PERM applications, the determination is valid only if the information on this form duplicates the information on form ETA 9089.
The New Mexico Department of Workforce Solutions makes every effort to complete wage determinations within five working days, but delays
may occur. You will be contacted if a delay of more than ten days is likely. Regulations allow up to 14 working days for completion of wage
determinations.
Rev 04-08
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