Carnegie Mellon University
Warner Hall, Third Floor
Pittsburgh, PA 15213
Students & Scholars: oie@andrew.cmu.edu
Tel: 412.268.5231
Study Abroad: goabroad@andrew.cmu.edu
Fax: 412.268.7832
Request Form for Labor Condition Application (LCA)
from Department to Office of International Education
Purpose
Carnegie Mellon Departments use this form to inform OIE of a pending LCA request with Human Resources as a
part of the H-1B application process. Forward this form to OIE at the same time that the prevailing wage
information is sent to HR for processing:
Office of International Education, ATTN: H-1B Processing
rd
Warner Hall, 3
Floor, Carnegie Mellon University
Request and Certification
Department Information
Department Name _______________________
Contact_________________________________
Extension _____________________________
Email __________________________________
Employee Details
Scholar Name ___________________________
Job Title_________________________________
OES Occupational Code __________________
Rate of Pay ______________________________
Period of H-1B employment: from ___________
to __________
Full time or part time? _____________________
Is this for an H-1B extension? ____Yes ____ No
While the individual receive the standard CMU benefits package? ____Yes ____ No
Location where H-1B employee will work: ___CMU campus (Pittsburgh) __Other__________________
If a university-approved immigration attorney will be filing the H petition, please indicate the attorney’s
name:________________________________________
Certification
US Department of Labor requires the employer to certify that the following “Employer Labor
Conditions.” By signing below, the Department head or director agrees to:
Wages: pay non-immigrants at least the local prevailing wage or the employer’s actual wage,
whichever is higher, and pay for non-productive time. Offer non-immigrants benefits on the same
basis as US workers.
Working conditions: provide working conditions for non-immigrants which will not adversely affect
the working conditions of workers similarly employed.
Strike, lockout, or work stoppage: There is no strike, lockout or work stoppage in the named
occupation at the place of employment.
Notice: Notice to union or to workers has been or will be provided in the named occupation at the
place of employment. A copy of this form will be provided to each nonimmigrant worker employed
pursuant to the application.
_____________________________________________
______________________
Name and title of designated department representative
Date
_____________________________________________
Signature
Updated on 3/2013