Form Eta 750 - Application For Alien Employment Certification
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2OMB Approval No. 1205-0015
Expires: 04/30/2014
U.S. DEPARTMENT OF LABOR
IMPORTANT: READ CAREFULLY BEFORE COMPLETING THIS FORM
Employment and Training Administration
PRINT legibly in ink or use a typewriter. If you need more space to
answer questions in this form, use a separate sheet. Identify each answer
APPLICATION
with the number of the corresponding question. SIGN AND DATE each
sheet in original signature.
FOR
To knowingly furnish any false information in the preparation of this form
and any supplemental thereto or to aid, abet, or counsel another to do so is
ALIEN EMPLOYMENT CERTIFICATION
a felony punishable by $10,000 fine or 5 years in the penitentiary, or both
(18 U.S.C. 1001)
PART A. OFFER OF EMPLOYMENT
1. Name of Alien
(Family name in capital letter, First, Middle, Maiden)
2. Present Address of Alien
(Number, Street, City and Town, State ZIP code or Province, Country)
3. Type of Visa (if in U.S.)
The following information is submitted as an offer of employment
4. Name of Employer
(Full name of Organization)
| 5. Federal Taxpayer ID -- EIN
|
|
|
6. Address
(Number, Street, City and Town, State ZIP code)
7. Address Where Alien Will Work
(if different than Item 6)
8. Nature of Employer’s Business
9. Name of Job Title
10. Total Hours Per Week
11. Work
12. Rate of Pay
Activity
Schedule
a. Basic
b. Overtime
a. Basic
b. Overtime
(Hourly)
$
$
a.m.
p.m.
per ________
per ________
13. Describe Fully the job to be Performed
(Duties)
14. State in detail the MINIMUM education, training, and experience for a
15. Other Special Requirements
worker to perform satisfactorily the job duties described in item 13
above.
Grade
High
College
College Degree Required
(specify)
EDU-
School
School
CATION
(Enter
Major Field of Study
number of
years)
No. Yrs.
No. Mos.
Type of Training
TRAIN-
ING
Related
Related Occupation
(specify)
Job Offered
Occupation
Number
EXPERI-
Yrs.
Mos.
Yrs.
Mos.
ENCE
16. Occupational Title of
17. Number of
Person Who Will Be
Employees
Alien’s Immediate Supervisor
Alien Will Supervise
ENDORSEMENTS
(Make no entry in section – for Government use only)
Date Forms Received
L.O.
S.O.
R.O.
N.O.
Ind. Code
Occ. Code
Occ. Title
ETA 750 (Nov. 2007)
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