I
ARIZONAi@JWORK™
Innovative Workforce Solutions
WIO-1057A FORPDF (2-17)
Page 1 of 4
Workforce Innovation and Opportunity Act (WIOA)
H-2B Foreign Labor SWA Job Order Form
Foreign Labor Certification Unit
318 N Florence Street, Suite C, Casa Grande, AZ 85122
Submit to Desirae Diaz at
ddiaz@azdes.gov
or fax to (520) 836-5876.
Call (520) 866-3608 for any questions.
Did you receive a Prevailing Wage Determination for this H-2B job order?
No
Yes
EMPLOYER INFORMATION:
Employer/Business Name:
If applicable, Doing Business As (DBA):
FEIN:
Type of Business:
Business address:
City:
State:
ZIP Code:
Mailing address, if different:
City:
State:
ZIP Code:
Contact Person:
Title:
E-Mail Address:
Phone:
Fax:
JOB ORDER INFORMATION:
Worksite, if different from business address:
Daily travel to/from worksite provided:
No
Yes If yes, designated pickup location:
Title of job opening:
Number of openings:
Education required:
Experience required (in months):
Will you accept a trainee?
No
Yes
Will on-the-job training (OJT) be provided?
No
Yes
Driver’s License required:
No
Yes
Class
Drug Testing:
No
Yes
Pre
Post
Job is: Full-time, temporary and (check one):
peak load
seasonal
one-time occurrence
intermittent
Dates of Employment: Start Date:
End Date:
Work Hours: Start time:
Total hours per week:
End Time:
Work days:
Sun
Mon
Tues
Wed
Thurs
Fri
Sat
Varies
Salary: $
to $
per
Overtime offered:
No
Yes If yes, at what rate:
Pay Day: What day of the week:
Frequency of Pay:
Weekly
Bi-Weekly
See page 3 for EOE/ADA/LEP/GINA disclosures