Form Eta 750 - Application For Alien Employment Certification Page 2
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2(Complete)
18. COMPLETE ITEMS ONLY IF JOB IS TEMPORARY
19. IF JOB IS UNIONIZED
a. No. of Open-
b. Exact Dates You Expect
a. Number
b. Name of Local
ings To Be
To Employ Alien
of
Filled By Aliens
Local
From
To
Under Job Offer
c. City and State
20. STATEMENT FOR LIVE-AT-WORK JOB OFFERS
(Complete for Private Household Job ONLY)
a. Description of Residence
b. No. Persons Residing at Place of Employment
c. Will free board and private
("X" one)
room not shared with any-
Children
Ages
("X" one)
Number of
Adults
YES
NO
one be provided?
Rooms
BOYS
House
GIRLS
Apartment
21. DESCRIBE EFFORTS TO RECRUIT U.S. WORKERS AND THE RESULTS.
(Specify Sources of Recruitment by Name)
Applications require various types of documentation. Please read PART II of the instructions to assure that appropriate
22.
supporting documentation is included with your application.
23. EMPLOYER CERTIFICATIONS
By virtue of my signature below,
the following conditions of employment.
I HEREBY CERTIFY
a.
I have enough funds available to pay the wage or salary
e.
The job opportunity does not involve unlawful discri-
offered the alien.
mination by race, creed, color, national origin, age, sex,
religion, handicap, or citizenship.
b.
The wage offered equals or exceeds the prevailing wage
f.
The job opportunity is not
:
and I guarantee that, if a labor certification is granted, the
wage paid to the alien when the alien begins work will
(1) Vacant because the former occupant is on strike or is
equal or exceed the prevailing wage which is applicable at
being locked out in the course of a labor dispute
the time the alien begins work.
involving a work stoppage.
(2) At issue in a labor dispute involving a work stoppage.
c.
The wage offered is not based on commissions, bonuses,
or other incentives, unless I quarantee a wage paid on a
g.
The job opportunity's terms, conditions and occupational
weekly, bi-weekly or monthly basis.
environment are not contrary to Federal, State or local
law.
d.
I will be able to place the alien on the payroll on or before
the date of the alien's proposed entrance into the United
h.
The job opportunity has been and is clearly open to any
States.
qualified U.S. worker.
24. DECLARATIONS
>
DECLARATION
Pursuant to 28 U.S.C. 1746, I declare under penalty of perjury the foregoing is true and correct.
OF
EMPLOYER
SIGNATURE
DATE
NAME
(Type or Print)
TITLE
>
I HEREBY DESIGNATE
the agent below to represent me for the purposes of labor certification and
I TAKE
AUTHORIZATION OF
AGENT OF EMPLOYER
for accuracy of any representations made by my agent.
FULL RESPONSIBILITY
SIGNATURE OF EMPLOYER
DATE
NAME OF AGENT
(Type or Print)
ADDRESS OF AGENT
(Number, Street, City, State, ZIP Code)
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