OMB Approval No. 44-R1301

PART A. OFFER OF EMPLOYMENT
1. Name of Alien (Family name in capital letters, First, Middle, Maiden)
2. Present Address of Alien (Number, Street, City and Town, State ZIP Code or Province, Country)
Type of Visa (If in U.S.)
The following information is submitted as evidence of an offer of employment.
4. Name of Employer (Full name of organization)
5. Telephone (Area Code and Number)
Address (Number, Street, City or Town, Country, State, ZIP Code
7. Address Where Alien Will Work (if different form item 6)
8. Nature of Employer’s Business Activity
9. Name of Job Title
10. Total Hours Per Week	11. Work
Schedule
(Hourly)
a.m.
p.m.	12. Rate of Pay
Basic

Overtime

Basic

/hr	Overtime

13. Describe Fully the Job to be Performed (Duties)
14. State in detail the MINIMUM education, training, and experience for a worker to perform satisfactorily the job duties described in Item 13 above.	15. Other Special Requirements
EDU-CATION (Enter number of years)	Grade School	High School	College	College Degree Required (Specify)
Major Field of Study
TRAIN-ING	No. Yrs.	No. Mos.	Type of Training
EXPERI-ENCE	Job Offered	Related Occupation	Related Occupation (specify)
Number
Yrs	Mos	Yrs	Mos
Occupational Title of
Person Who Will Be ((
Alien’s Immediate Supervisor
Vice President and Owner	17. Number of
Employees (
Alien Will Supervise
( (

( (	(ENDORSEMENTS (Make no entry in
section – for government use only)
Date Forms Received
L.O.	S.O.
R.O.	N.O.
Ind. Code	Occ. Code
Occ. Title
Replaces MA 7-50A, B and C (Apr. 1970 edition) which is obsolete.	ETA 750 (Oct. 1979)

18. COMPLETE ITEMS ONLY IF JOB IS TEMPORARY	19. IF JOB IS UNIONIZED (Complete)
a. No. of Open
-ings To Be
Filled By Aliens
Under Job Offer
b. Exact Dates You Expect
To Employ Alien	a. Number
of
local	b. Name of Local
From	To
c. City and State
20. STATEMENT FOR LIVE-AT-WORK JOB OFFERS (Complete for Private Household Job ONLY)
a. Description of Residence	b. No. Persons	c. Will free board and private
room not shared with anyone
be provided? (“X” one)
( YES ( NO
(“X” one)
( House
( Apartment	Number of
Rooms	Adults	Boys	Children	Ages
Girls
21. DESCRIBE EFFORTS TO RECRUIT US WORKERS AND THE RESULTS. (Specify sources of Recruitment by Name)
22. Applications require various types of documentation. Please read PART II of the instructions to assure that appropriate supporting documentation is included with your application.
23. EMPLOYER CERTIFICATIONS
By virtue of my signature below, I HEREBY CERTIFY the following conditions of employment.
I have enough funds available to pay the wage or salary offered the alien.

The wage offered equals or exceeds the prevailing wage and I guarantee that, if a labor certification is granted, the wage paid to the alien when the alien begins work will equal or exceed the prevailing wage which is applicable at the time the alien begins work.

The wage offered is not based on commissions, bonuses, or other incentives, unless I guarantee a wage paid on a weekly, bi-weekly or monthly basis.

I will be able to place the alien on the payroll on or before the date of the alien’s proposed entrance into the United States.	The job opportunity does not involve unlawful discrimination by race, creed, color, national origin, age, sex, religion, handicap, or citizenship.

The job opportunity is not:

Vacant because the former occupant is on strike or is being locked out in the course of a labor dispute involving a work stoppage.

At issue in a labor dispute involving a work stoppage.

The job opportunity’s terms, conditions and occupational environment are not contrary to Federal, State or local law.

The job opportunity has been and is clearly open to any qualified U.S. worker.
24. DECLARATIONS
DECLARATION
OF ( EMPLOYER
Pursuant to 28 U.S.C. 1746, I declare under penalty of perjury the foregoing is true and correct.
SIGNATURE	DATE
NAME (TYPE OR PRINT)
TITLE
AUTHORIZATION OF (

AGENT OF EMPLOYER	I HEREBY DESIGNATE the agent below to represent me for the purposes of labor certification and I TAKE FULL RESPONSIBILITY for accuracy of any representations made by my agent.
SIGNATURE OF EMPLOYER
DATE
NAME OF AGENT (Type or Print)	ADDRESS OF AGENT (Number, Street, City, State ZIP Code)

IMPORTANT: READ CAREFULLY BEFORE COMPLETING THIS FORM

PRINT legibly in ink or use a typewriter. If you need more space to answer questions on this form, use a separate sheet. Identify each answer with the number of the corresponding question. SIGN AND DATE each sheet in original signature.
To knowingly furnish any false information in the preparation of this form and any supplement thereto or to aid, abet, or counsel another to do so is a felony punishable by $10,000 fine or 5 years in the penitentiary, or both.(18 U.S.C. 1001).

U.S. DEPARTMENT OF LABOR
Employment and Training Administration
APPLICATION
FOR
ALIEN EMPLOYMENT CERTIFICATION

Melanie White

2002-01-15

carl d. reavis