Actual Wage Determination Worksheet And Memorandum For Lca File-(Fillable) Page 3
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1
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3Form 2 Memorandum to Labor Condition Application File
Department/College where position is located __________________________________
Position title and specific, physical address where duties will be performed____________
________________________________________________________________________
________________________________________________________________________
In this department there are ____________number of comparable employees holding the
same position title and perform ing similar job duties as the position listed above. The
salary range for those who are comparable to the foreign national are: (if full-time, per
year; if part-time, per hour)
$_______________________to $_____________________ per ________________
Within the salary range above, a com
parable individual’s salary is determ ined by
considering the factors checked below.
____ Level of education related to what is required by the position
____ Level of experience and training related to what is required by the position
____ Level of job duties and responsibilities has increased since being hired
____ Specialized knowledge relevant to the position
____ Other legitimate business-related factors which are used by this department to
determine salary as listed below:
________________________________________________________________________
________________________________________________________________________
I hereby certify that the actua l wage determination provided on Form 2 reflects accu rate
information of all sim ilarly employed individuals working in this departm ent. I am able
to provide evidence of any wage differen ces among the similarly employed individuals
working in this department based on the legitimate business-related criteria listed above.
My name and title (print) ___________________________________________________
My signature________________________________________Date_________________
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