Fillable Application for Temporary Employment Certification ETA Form 9142 (ILW.COM)

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Application for Temporary Employment Certification ETA Form 9142 (ILW.COM)

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OMB Approval: 1205-0466
Expiration Date: 04/30/2015
Application for Temporary Employment Certification
ETA Form 9142
U.S. Department of Labor
ETA Form 9142 FOR DEPARTMENT OF LABOR USE ONLY Page 1 of 6
Case Number: ______________________ Case Status: __________________ Validity Period: ______________ to _______________
Please read and review the filing instructions carefully before completing the ETA Form 9142. A copy of the instructions can be found
at http://www.foreignlaborcert.doleta.gov/. In accordance with Federal Regulations, incomplete or obviously inaccurate applications
will not be certified by the Department of Labor. If submitting this form non-electronically, ALL required fields/items containing an
asterisk ( * ) must be completed as well as any fields/items where a response is conditional as indicated by the section ( § ) symbol.
A. Employment-Based Nonimmigrant Visa Information
1. Indicate the type of visa classification supported by this application (Write classification symbol): *
B. Temporary Need Information
1. Job Title *
2. SOC (ONET/OES) code *
3. SOC (ONET/OES) occupation title *
4. Is this a full-time position? *
Yes No
Period of Intended Employment
5. Begin Date *
(mm/dd/yyyy)
7. Total workers being requested for temporary labor certification in the job opportunity
for the visa classification *
7a. Total workers employed in the job opportunity from the prior year
a. Total workers * c. Total workers in the visa classification *
(recruited from outside the U.S. and employed)
b. Total U.S. workers * d. Total workers in the visa classification *
(recruited from inside the U.S. and employed)
8. Nature of Temporary Need: (Choose only one of the standards) *
Seasonal Peakload One-Time Occurrence Intermittent or Other Temporary Need
8a. For H-2B Applications ONLY, please enter the H-2B Registration
Number (from an approved ETA Form 9155), if applicable. *
9. Statement of Temporary Need *
OMB Approval: 1205-0466
Expiration Date: 04/30/2015
Application for Temporary Employment Certification
ETA Form 9142
U.S. Department of Labor
ETA Form 9142 FOR DEPARTMENT OF LABOR USE ONLY Page 2 of 6
Case Number: ______________________ Case Status: __________________ Validity Period: ______________ to _______________
C. Employer Information
Important Note: Enter the full name of the individual employer, joint employer, job contractor, partnership, corporation and all other required
information in this section. For joint employer or master applications filed on behalf of more than one employer, identify the main or primary
employer in the section below and then submit a separate attachment that identifies each additional employer, by name, mailing address,
and total worker positions needed, under the application.
1. Legal business name *
2. Trade name/Doing Business As (DBA), if applicable
3. Address 1 *
4. Address 2
5. City *
6. State *
7. Postal code *
8. Country *
9. Province
10. Telephone number *
11. Extension
12. Federal Employer Identification Number (FEIN from IRS) *
13. NAICS code (must be at least 4-digits) *
14. Type of employer application (choose only one box below) *
Individual Employer Association – Sole Employer (H-2A only)
H-2A Labor Contractor or Association – Joint Employer (H-2A only)
H-2B Job Contractor Association – Filing as Agent (H-2A only)
Joint Employer (H-2B only)
D. Employer Point of Contact Information
Important Note: The information contained in this Section must be that of an employee of the employer who is authorized to act on behalf of
the employer in labor certification matters. The information in this Section must be different from the agent or attorney information listed in
Section E, unless the attorney is an employee of the employer. For joint employer or master applications filed on behalf of more than one
employer under, enter only the contact information for the main or primary employer (e.g., contact for an association filing as a joint
employer) under the application.
1. Contact’s last (family) name *
2. First (given) name *
3. Middle name(s)
4. Contact’s job title *
5. Address 1 *
6. Address 2
7. City *
8. State *
9. Postal code *
10. Country *
11. Province
12. Telephone number *
13. Extension
14. E-Mail address
OMB Approval: 1205-0466
Expiration Date: 04/30/2015
Application for Temporary Employment Certification
ETA Form 9142
U.S. Department of Labor
ETA Form 9142 FOR DEPARTMENT OF LABOR USE ONLY Page 3 of 6
Case Number: ______________________ Case Status: __________________ Validity Period: ______________ to _______________
E. Attorney or Agent Information (If applicable)
1. Is/are the employer(s) represented by an attorney or agent in the filing of this application
(including associations acting as agent under the H-2A program)? If “Yes”, complete Section E. *
Yes No
2. Attorney or Agent’s last (family) name §
3. First (given) name §
4. Middle name
5. Address 1 §
6. Address 2
7. City §
8. State §
9. Postal code §
10. Country §
11. Province
12. Telephone number §
13. Extension
14. E-Mail address
15. Law firm/Business name §
16. Law firm/Business FEIN §
17. State Bar number (only if attorney) §
18. State of highest court where attorney is in good
standing (only if attorney) §
19. Name of the highest court where attorney is in good standing (only if attorney) §
F. Job Offer Information
a. Job Description
1. Job Title *
2. Number of hours of work per week
Basic *: _______ Overtime: _______
3. Hourly Work Schedule *
A.M. (h:mm): ___ : ____ P.M. (h:mm): ___ : ____
4. Does this position supervise the work of other employees? *
Yes No
4a. If yes, number of employees
worker will supervise (if applicable) § ______
5. Job duties – A description of the duties to be performed MUST begin in this space. If necessary, add attachment
to continue and complete description. *
OMB Approval: 1205-0466
Expiration Date: 04/30/2015
Application for Temporary Employment Certification
ETA Form 9142
U.S. Department of Labor
ETA Form 9142 FOR DEPARTMENT OF LABOR USE ONLY Page 4 of 6
Case Number: ______________________ Case Status: __________________ Validity Period: ______________ to _______________
F. Job Offer Information (continued)
b. Minimum Job Requirements
1. Education: minimum U.S. diploma/degree required *
None High School/GED Associate’s Bachelor’s Master's Doctorate (PhD) Other degree (JD, MD, etc.)
1a. If “Other degree” in question 1, specify the diploma/
degree required §
1b. Indicate the major(s) and/or field(s) of study required §
(May list more than one related major and more than one field)
2. Does the employer require a second U.S. diploma/degree? *
Yes No
2a. If “Yes” in question 2, indicate the second U.S. diploma/degree and the major(s) and/or field(s) of study required §
3. Is training for the job opportunity required? *
Yes No
3a. If “Yes” in question 3, specify the number of
months of training required §
3b. Indicate the field(s)/name(s) of training required §
(May list more than one related field and more than one type)
4. Is employment experience required? *
Yes No
4a. If “Yes” in question 4, specify the number of
months of experience required §
4b. Indicate the occupation required §
5. Special Requirements - List specific skills, licenses/certifications, and requirements of the job opportunity. *
c. Place of Employment Information
1. Worksite address 1 *
2. Address 2
3. City *
4. County *
5. State/District/Territory *
6. Postal code *
7. Will work be performed in multiple worksites within an area of intended
employment or a location(s) other than the address listed above? *
Yes No
7a. If Yes in question 7, identify the geographic place(s) of employment with as much specificity as possible. If necessary,
submit an attachment to continue and complete a listing of all anticipated worksites. §
OMB Approval: 1205-0466
Expiration Date: 04/30/2015
Application for Temporary Employment Certification
ETA Form 9142
U.S. Department of Labor
ETA Form 9142 FOR DEPARTMENT OF LABOR USE ONLY Page 5 of 6
Case Number: ______________________ Case Status: __________________ Validity Period: ______________ to _______________
G. Rate of Pay
1. Basic Rate of Pay Offered *
From: To (Optional):
1a. Overtime Rate of Pay (if applicable) §
From: To (Optional):
2. Per: (Choose only one) *
Hour Week Bi-Weekly Month Year Piece Rate
2a. If Piece Rate is indicated in question 2, specify the wage offer requirements: §
2b. For H-2B Applications ONLY, please enter the Prevailing
Wage Determination tracking number (ETA Form 9141) *
3. Additional Wage Information (e.g., multiple worksite applications, itinerant work, or other special procedures).
If necessary, add attachment to continue and complete description. §
H. Declaration of Employer and Attorney/Agent
In accordance with Federal regulations, the employer must attest that it will abide by certain terms, assurances and obligations as a condition
for receiving a temporary labor certification from the U.S. Department of Labor. Applications that fail to attach Appendix A.2 or Appendix B.1 will
be considered incomplete and not accepted for processing by the ETA application processing center.
1. For H-2A Applications ONLY, please confirm that you have read and agree to all the
applicable terms, assurances and obligations contained in Appendix A.2. §
Yes No N/A
2. For H-2B Applications ONLY, please confirm that you have read and agree to all the
applicable terms, assurances and obligations contained in Appendix B.1. §
Yes No N/A
I. Preparer
Complete this section if the preparer of this application is a person other than the one identified in either Section D (employer point of contact) or
E (attorney or agent) of this application.
1. Last (family) name §
2. First (given) name §
3. Middle name
4. Job Title §
5. Firm/Business name §
6. E-Mail address §
$ _____ . ____
$ _____ . ____
$ _____ . ____
$ _____ . ____
OMB Approval: 1205-0466
Expiration Date: 04/30/2015
Application for Temporary Employment Certification
ETA Form 9142
U.S. Department of Labor
ETA Form 9142 FOR DEPARTMENT OF LABOR USE ONLY Page 6 of 6
Case Number: ______________________ Case Status: __________________ Validity Period: ______________ to _______________
J. U.S. Government Agency Use (ONLY)
Pursuant to the provisions of Section 101(a)(15)(h)(ii) of the Immigration and Nationality Act, as amended, I hereby certify that
there are not sufficient U.S. workers who are qualified and who will be available to perform the temporary services or labor for
which an employer desires to import foreign workers and the employment of the foreign workers will not adversely affect the
wages and working conditions of U.S. workers similarly employed. By virtue of the signature below, the Department of Labor
hereby acknowledges the following:
______________________________________________ ______________________________
Case number Receipt Date
______________________________________________ ______________________________
Case Status Total Worker Positions Certified
______________________________________________ ______________________________
Validity Period From Validity Period To
______________________________________________ ______________________________
Department of Labor, Office of Foreign Labor Certification Determination Date (date signed)
OMB Paperwork Reduction Act (1205-0466)
Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Public reporting
burden for this collection of information is estimated to average 3 hours 20 minutes per response for H-2A and 2 hours 40 minutes for H-2B,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. The obligation to respond to this data collection is required to obtain/retain benefits (Immigration and
Nationality Act, 8 U.S.C. 1101, et seq.). Please send comments regarding this burden estimate or any other aspect of this information
collection to the Office of Foreign Labor Certification * U.S. Department of Labor * Room C4312 * 200 Constitution Ave., NW, * Washington,
DC * 20210 or by email ETA.OFLC.Forms@dol.gov. Please do not send the completed application to this address.
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Application for Temporary Employment Certification ETA Form 9142 (ILW.COM)

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Completed 9 January 2021

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