Eta Form 9141 - Application For Prevailing Wage Determination printable pdf download

Eta Form 9141 - Application For Prevailing Wage Determination

OMB Approval: 1205-0466

Expiration Date: 03/31/2016

Application for Prevailing Wage Determination

ETA Form 9141

U.S. Department of Labor

Please read and review the instructions carefully before completing this form and print legibly. A copy of the instructions can be

found at

A. Employment-Based Visa Information

PERM

1. Indicate the type of visa classification supported by this application

: *

(Write classification symbol)

B. Requestor Point-of-Contact Information

1. Contact’s last (family) name *

2. First (given) name *

3. Middle name(s) *

CALLAN

JOHNPAUL

N/A

4. Contact’s job title *

Attorney

5. Address 1 *

11480 SUNSET HILLS ROAD, SUITE 120E

6. Address 2

N/A

7. City *

8. State *

9. Postal code *

RESTON

20190

10. Country *

11. Province (if applicable)

UNITED STATES OF AMERICA

N/A

12. Telephone number *

13. Extension

14. Fax Number

914-483-7769

N/A

15. E-Mail Address

C. Employer Information

1. Legal business name *

Christian Siding LLC

2. Trade name/Doing Business As (DBA), if applicable §

N/A

3. Address 1 *

14121 Parke Long Court

4. Address 2

N/A

5. City *

6. State *

7. Postal code *

Chantilly

20151

8. Country *

9. Province (if applicable)

N/A

UNITED STATES OF AMERICA

10. Telephone number *

11. Extension

571-402-1955

N/A

12. Federal Employer Identification Number

13. NAICS code

(FEIN from IRS) *

(must be at least 4-digits) *

270632083

23611

D. Wage Processing Information

1. Is the employer covered by ACWIA? *

 Yes  No

2. Is the position covered by a Collective Bargaining Agreement (CBA)? *

 Yes  No

3. Is the employer requesting consideration of Davis-Bacon (DBA) or McNamara Service

 Yes  No

Contract (SCA) Acts? *

 DBA  SCA

ETA Form 9141

Page 1 of 6

FOR DEPARTMENT OF LABOR USE ONLY

Case Number:________________ Case Status: _________________________________________ Validity Period:______________ to _______________

02/09/2016

06/30/2016

P-100-15324-573024

DETERMINATION ISSUED

Eta Form 9141 - Application For Prevailing Wage Determination

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