Eta Form 9035 & 9035e Draft - Labor Condition Application For Nonimmigrant Workers (Page 3 of 6) in pdf

OMB Approval: 1205-0310

Expiration Date:

XX/XX/XXXX

Labor Condition Application for Nonimmigrant Workers

ETA Form 9035 & 9035E

U.S. Department of Labor

F. Employment and Wage Information

Important Note: The employer must define the intended place(s) of employment with as much geographic specificity as possible. Each

intended place(s) of employment listed below must be the worksite or physical location where the work will actually be performed and

cannot be a P.O. Box. The employer must identify all intended places of employment on the LCA. 20 CFR 655.730(c)(5). If the employer

is submitting this form non-electronically and the work is expected to be performed in more than one location, an attachment must be

submitted in order to complete this section. An employer has the option to use either a single Form ETA 9035 or multiple forms to disclose

all intended places of employment. If the employer has more than three (3) intended places of employment at the time of filing this

application, the employer must file as many additional LCAs as are necessary to list all intended places of employment. See the form

instructions for further information about identifying all intended places of employment.

Place of Employment Information 1

1. Enter the estimated number of workers that will perform work at this place of employment under

the LCA.*

2. Indicate whether the worker(s) subject to this LCA will be placed with a secondary employer at this

 Yes

 No

place of employment. *

3. If “Yes” to question 2, provide the legal business name of the secondary employer. §

4. Address 1 *

5. Address 2

6. City *

7. County *

8. State/District/Territory *

9. Postal code *

10. Wage Rate Paid to Nonimmigrant Workers *

10a. Per: (Choose only one)*

 Hour  Week  Bi-Weekly  Month  Year

From:

To:

$ __________ . ____

11. Prevailing Wage Rate *

11a. Per: (Choose only one)*

 Hour  Week  Bi-Weekly  Month  Year

$ __________ . ____

Questions 12-14. Identify the source used for the prevailing wage (PW) (check and fully complete only one): *

12.

a. PWD tracking number §

A Prevailing Wage Determination (PWD) issued by the Department of Labor

13.

A PW obtained independently from the Occupational Employment Statistics (OES) Program

a. Wage Level

b. Source Year §

(check one):



III

N/A

14.

A PW obtained using another legitimate source (other than OES) or an independent authoritative source

a. Source Type

b. Source Year §

(check one):



CBA

DBA

SCA

Other/ PW Survey

c. If responded “Other/ PW Survey” in question 14.a, enter the name of the survey producer or publisher §

d. If responded "Other/ PW Survey" in question 14.a, enter the title or name of the PW survey §

Form ETA 9035/9035E

FOR DEPARTMENT OF LABOR USE ONLY

Page 3 of 6

Case Number:_______________________ Case Status: __________________ Period of Employment: ______________ to _______________

Eta Form 9035 & 9035e Draft - Labor Condition Application For Nonimmigrant Workers Page 3

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