OMB Approval: 1205-0466 Expiration Date: 11/30/2011 Application for Temporary Employment Certification ETA Form 9142 I .. U.S. Department of Lait'gE Please read and review the ?ling instructions carefully before'completing the 912a?: copy of the instructions can be found at in accordance with Federal Regulations, incomplete or obviously inaccurate applications will not be certi?ed by the Department of Labor. lf submi 's Each of ally, ALL required ?elds/items containing an asterisk must be completed as well as any fields/it ereg??rggi? is! oh it?lonal as indicated by the section(?) symbol. L. A. Employment-Based Nonimmigrant Visa Information 1. indicate the type of visa Classi?cation supported by this application (Write classi?cation symbol): B. Temporary Need Information 1. Job Title Stable Attendant 2. SOC (ONETIOES) code 3. SOC (ONETIOES) occupation title 45-209300 Farm Worker Ranch Animal 4. Is this a full-time position? Period of intended Employment Yes No 5. Begin Date *?011207?201-1?? 6. End Date *11/20/2011 O) I as 70? NC) Worker positions needed/basis for the visa classification supported by i?appw$6n \i 1?Na? ?ly?lr? 13-X Total Worker Positions Being Requested for Certi?cation Basis for the visa classi?cation supported by this application (indicate the total workers in each applicable category based on the total workers identi?ed above) 13-X a. New employment of. New concurrent employment b. Continuation of previously approved employment without change with the same employer e. Change in employer c. Change in previously approved employment Amended petition awe 8. Nature of Temporary Need: (Choose only one of the standards) Seasonal Peakload One-Time Occurrence intermittent or Other Temporary Need 9. Statement of Temporary Need Three Chimneys Farm is facing a distinct labor crisis and cannot locate or retain American workers to ?ll the position of Stable Attendant. Obtaining H-2A visas for thirteen (13) foreign Stable Attendants is critical to the success of my Client?s overall breeding, foaling, weaning and yearling preparation operation. Three Chimneys Farm's breeding season begins on January 20, 2011. Thereafter, Three Chimneys Farm enters into its foaling season which is scheduled to conclude on approximately July 15, 2011. Following its foaling season, my Client enters into its weaning and yearling preparation season which is scheduled to conclude on November 20, 2011. It is imperative that Three Chimneys Farm hire thirteen (13) foreign Stable Attendants by the January?207- 1-1?breeding season start date. This hire will ensure that my Client?s operation is conducted in a manner that will aI it to maintain its success in the horse industry. Without the addition of these foreign Stable Attendants. my Client wil not have the necessary staff in place to handle the temporary work load that begins with the breeding season in January. uring the off-season months of November 20, 2011 through January 20, 2012, my Client is able to successfully opera with their staff of permanent employees. These employees include permanent horse workers, bookkeepers, an management staff.? 02leij ETA Form 91 Case Numbcr?_ Di FOR ARTME 1? OF LABOR USE ONLY garb-Eta} Page 1 of 6 Case Status: Validity Period: ll toll!9~0l\ "at! l. .zm?wn 1-: .i Elissadecas- 9 5 it?l OMB Approval: 1205-0465 Expiration Date: 111302011 Application for Temporary Employment Certification ETA Form 9142 U.S. Department of Labor C. Employer Information Important Note: Enter the full name of the individual employer, partnership, or corporation and all other required information in this section. For joint employer or master applications filed on behalf of more than one employer under the H-2A program, identify the main or primary employer in the section below and then submit a separate attachment that identifies each employer, by name, mailing address, and total worker positions needed, under the application. 1. Legal business name Three Chimneys Farm 2. Trade name/Doing Business As (DBA), if applicable 3. Address 1 1981 Old Frankfort Pike 4. Address 2 5. City 6. State 7. Postal code Versailles KY 40383 8. Country . 9. Province USA 10. Telephone number 11. Extension 859-873-7053 12. Federal Employer Identi?cation Number (FEIN from 13. NAICS code (must be at least 4-dlgits) 112920 14. Type of employer application (choose only one box below) individual Employer Association Sole Employer only) H-2A Labor Contractor or Association Joint Employer (l-l-2A only) Job Contractor Association Filing as Agent (H-2A 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 the H-2A program. enterm the contact information for the main or primary employer contact for an association filing as joint employer) under the application. 1. Contact's last (family) name 2. First (given) name 3. Middle name(s) Williams LaTerri 4. Contact?siob title Director of Human Resources 5. Address 1 1981 Old Frankfort Pike 6. Address 2 7. City 8. State 9. Postal code Versailles KY 40383 10. Country" 11. Province USA 12. Telephone number* 13. Extension 14. E-Mail address 859?87357053 ETA Form 9142 FOR OF LABOR USE ONLY a Ef?e.) Case Number: ?gs-?Li Case Status: g- 2 f6 Validity Period: to OMB Approval: 1205-0466 Expiration Date: 11l30l2011 Application for Temporary Employment Certification ETA Form 9142 US. Department of Labor E. Attorney or Agent Information (If applicable) 1. ls/are the employer(s) represented by an attorney or agent in the ?ling of this application (including associations acting as agent under the H-2A program)? If "Yes". complete Section E. es 0 2. Attorney or Agent?s last (family) name 3. First (given) name 4. Middle name(s) Conley-Morgan Laura Elizabeth 5. Address1 901 N. Broadway 6. Address 2 7. City - 8. State 9. Postal code Lexington KY 40505 10. Country 11. Province USA Fayette 12. Telephone number 13. Extension 14. EeMail address 859-268?7705 15. Law ?rm/Business name 16. Law firm/Business FEIN Conley?Morgan Law Group, PLLC 17. State Bar number (only if attorney) 18. State of highest court where attorney is in good 90110 standing (only if attorney) Kentucky 19. Name of the highest court where attorney is in good standing (only if attorney) Eastern District of US. Supreme Court F. Job Offer Information a. Job Description 1. Job Title Stable Attendant 2. Number of hours of work per week 3. Hourly Work Schedule Basic *1 it; Overtime: AM. (Ir-mm): 00 PM. (hsmm): 99 4. Does this position supervise the work of other employees? 43. if yes. number of employees Yes No 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. Workers will care for horses to protect their health and improve their appearance in conjunction with their assistance during the employer?s breeding, foaling, weaning and yearling preparation season. Workers will provide water for the employer's horses and will measure, mix, and apportion feed and feed supplements according to feeding instructions during the aforementioned season. ETA Form 9142 FOR DE RT ENT LABOR USE ONLY gt: 3 f6 Case 940$ Case Status: Validity Period: to I 3 OMB Approval: 1205-0466 Expiration Date: 11/30/2011 Application for Temporary Employment Certification ETA Form 9142 U.S. Department of Labor F. Job Offer Information (continued) b. Minimum Job Requirements 1. Education: minimum U.S. diploma/degree required None High School/GED Associate?s El Bachelor's Master's Doctorate Other degree (JD, MD, etc.) 1a. If ?Other degree" in question 1. specify the diploma/ 1b. Indicate the major(s) and/or field(s) of study required degree required (May list more than one related major and more than one field) 2. Does the employer require a second U.S. diploma/degree? I Yes No 23. 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? in question 3, specify the number of 3b. Indicate the oftraining required months of training required (May iist more than one related field and more than one type) 4. is employment experience required? I Yes No 43. if ?Yes? in question 4, specify the number of 4b. Indicate the occupation required months of experience required 5. Special Requirements - List specific skills, licenses/certi?cations, and requirements of the job opportunity. 0. Place of Employment Information 1. Worksite address 1 1981 Old Frankfort Pike 2. Address 2 3. City 4. County Versailles Woodford 5. 6. Postal code KY 40383 7. Will work be performed in multiple worksites within an area of intended Yes No employment or a location(s) other than the address listed above? 7a. If Yes in question 7. identify the geographic place(s) of employment with as much speci?city as possible. If necessary, submit an attachment to continue and complete a listing of all anticipated worksites. ETA Form 9 I42 FOR I) CIA LABOR USE ONLY Ptge 4 0 6 Case Number:( Di. 35? Case Status: ?it! Validity Period OMB Approval: 1205-0466 Expiration Date: 11/30/2011 Application for Temporary Empioyment Certification ETA Form 9142 U.S. Department of Labor G. Rate of Pay 1. Basic Rate of Pay Offered 1a. Overtime Rate of Pay (if applicable) From: 9.71 To (Optional): 3; - From: $14.56 To (Optional): 3 - 2. Per: (Chooseonly one)* XHour Week Bi?Weekly [3 Month El Year Piece Rate 2a. If Piece Rate is indicated in question 2, specify the wage offer requirements: 3. Additional Wage Information multiple worksite applications, itinerant work, or other Special procedures). If necessary, add attachment to continue and complete description. Tax deductions will be made on US. workers only. The total wages offered by employer for the first week of work will be $388.40. If Overtime required pay rate is $14.56 per hr. Wage will comply with the full 2010 wage guarantee listed at 20 CFR employer will offer a wage rate that is the highest of the AEWR, the prevailing hourly wage or piece rate, the agreed upon collective bargaining agreement wage, or the Federal or State minimum wage. Travel and subsidence paid by employer. Employer is required to reimburse workers who are unable to provide receipts for their transportation expenses a minimum of $10.64 per day and $46.00 as the maximum amount if the worker is able to provide receipt Reasonable repair and cost of damage, other than that which is caused by normal wear and tear, may be deducted from wages of workers to be found responsible for damage to housing and furnishings. Workers will be charged for any willful damage to or loss of such tools and equipment. 4. For H-ZA applications where the rate of pay is based upon multiple crop or agricultural activities, please con?rm that Appendix A.1 is complete and being submitted with the ?ling Yes a No of this application. H. Recruitment Information 1. Name of State Workforce Agency (SWA) serving the area of intended employment KY Department of Employment Services 2. SWA job order identification number 2a. Start date of SWA job order 2b. End date of SWA job order KY0415057 11/17/2010 06/21/2011 3. ls there a Sunday edition of a newspaper (of general circulation) in the area of intended employment? El Yes No Name of Newspaper/Publication (in area ofintended employment) I Dates of Print Advertisement 4. From: To: 5. From: To: 6. Additional Recruitment Activities. Use the space below to identify the type(s) or source(s) of recruitment, geographic location(s) of recruitment, ?g the date(s) on which recruitment was conducted. If necessary, add attachment to continue and complete description. Three Chimneys Farm, has also attempted to recruit workers for its temporary Stable Attendant positions by utilizing and aggressive word of mouth campaign and all available local indUStry resources. ETA Form 9142 FOR 1) 7 '7 LABOR USE ONLY Page 0f6 Case Number: Case StatuszgI 1 Validity Period: to I . I OMB Approval: 1205-0466 Expiration Date: 11l30l2011 Application for Temporary Employment Certification ETA Form 9142 U.S. Department of Labor I. Declaration of Employer and AttorneyIAgent 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 certi?cation from the U.S. Department of Labor. Applications that fail to attach Appendix A2 or Appendix 8.1 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 N0 2. For H-ZB Applications ONLY, please con?rm that you have read and agree to all the applicable terms. assurances and obligations contained in Appendix 31 Yes No EMA J. Preparer Complete this section if the preparer of this application is a person other than the one identi?ed in either Section (employer point of contact) or (attorney or agent) of this application. 1. Last (family) name 5 2. First (given) name 3. Middle initial 4. Job Title 5 5. Firm/Business name 6. E-Mail address K. U.S. Government Agency Use (ONLY) Pursuant to the provisions of Section 101 of the Immigration and Nationality Act, as amended, I hereby certify that there are not sufficient U.S. workers available and the employment of the above will not adversely affect the wages and working conditions of workers in the U.S. similarly employed. By virtue of the signature below, the Department of Labor hereby acknowledges the following: This certi?cation is valid from 9? i? to i {9?5 i; MQLLI Department of Labor, Of?ce of Foreign Labor Certification Determination Date (date signed) C?Honuacguq Ceeh?tt Case number . Case Status L. OMB Paperwork Reduction Act (1205?0465) Persons are not required to respond to this collection of information unless it displays a currently valid OMB controt number. Respondent's reply to these reporting requirements is mandatory to obtain the benefits of temporary employment certification (immigration and Nationality Act, Section 101 Pubiic reporting burden for this collection of information is estimated to average 2 hours 10 minutes per response for H-2A and 2 hours 45 minutes for H-ZB, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate to the Office of Foreign Labor Certification U.S. Department of Labor Room C4312 200 Constitution Ave., NW Washington, DC 20210. Do NOT send the completed application to this address. ETA Form 914 FOR 7 LABOR USE ONLY Sage 6 f6 Case Number: ?9 5 Case Status: CA Validity Period: I to OMB Approval: 1205-0466 Expiration Date: 11/30/2011 Application for Temporary Employment Certification ETA Form 9142 APPENDIX AZ US. Department of Labor For Use in Filing Applications Under the H-2A Agricultural Program ONLY A. Attorney or Agent Declaration hereby certify that I am an employee of, or hired by, the employer listed in Section of the ETA Form 9142, and that have been designated by that employer to act on its behalf in connection with this application. if i am an agent and not an employee of the employer, than i have attached a Letter of Representation from the employer. lalso certify that to the best of my knowledge the information contained herein is true and correct. i understand that to knowingly furnish false information in the preparation of this form and any supplement hereto or to aid, abet, or counsel another to do so is a felony punishable by a $250,000 fine or 5 years in a Federal penitentiary or both (18 US. C. 1001). 1. Attorney or Agent's last (family) name Conley Morgan 2. First (given) name Elizabeth 3. Middle initial 4. Firm/Business name Conley Morgan Law Group, PLLC 5. E-Mail address 6. Signature 7. Date signed B. Employer Declaration By virtue of my signature below, i HEREBY CERTIFY the following conditions of employment: 1. The job opportunity is a full-time temporary position, the quali?cations for which do not substantially deviate from the normal and accepted quali?cations required by non-H-2A employers in the same or comparable occupations and crops. The worksite for which the employer is requesting H-2A certification does not currently have workers ori strike or being locked out in the course of a labor dispute. The job opportunity is and will continue to be open to any qualified U.S. worker regardless of race, color, national origin, age. sex, religion, handicap. or citizenship, and the employer has conducted and will continue to conduct the required recruitment, in accordance with regulations, and has been unsuccessful in locating sufficient numbers of qualified U.S. applicants for the job opportunity for which certi?cation is sought. Any US. workers who applied or apply for the job were or will be rejected only for lawful, job-related reasons, and the employer must retain records of all rejections as required by 20 CFR 655.167. The job opportunity offers US. workers no less than the same benefits, wages, and working conditions that the employer is offering, intends to offer, or will provide to H-2A workers and complies with the requirements at 20 CFR 655, Subpart B. The employer understands that it must offer, recruit at, and pay a wage that is the highest of the adverse effect wage rate in effect at the time the lob order is placed, the prevailing hourly or piece rate, the agreed-upon collective bargaining rate (CBA), or the Federal or State minimum wage, and, furthermore, that if a new Adverse Effect Wage Rate is published, or the employer is noti?ed of a new prevailing wage rate during the contract period, and that new rate is higher than the wage determined by the NPC (except the CBA) during the application process the employer will increase the pay of all employees in the same job occupation to the higher rate. There are no US. workers available in the area(s) capable of performing the temporary services or labor in the job opportunity, and the employer will conduct positive recruitment as specified by the NPC and continue to cooperate with the SWA by accepting referrals of all eligible US. workers who apply (or on whose behalf an application is made) for the job opportunity until completion of 50 percent of the contract period calculated from the first date of need indicated in Section 8.5 of ETA Form 9142. All fees associated with processing the temporary labor certification will be paid in a timely manner. ETA Form 9] 42 Appendix A.2 FOR DEPARTMENT OF LABOR USE ONLY Page A.l ofA.3 Case Status: Ce Period of Employment: to i OMB Approval: 1205-0466 Expiration Date: 1 1/30/201 1 Application for Temporary Employment Certification ETA Form 9142 APPENDIX A.2 US. Department of Labor 8. During the period of employment that is the subject of the labor certi?cation application. the emptoyer: Will comply with applicable Federal. State and local employment?related laws and regulations. inciuding health and safety laws; (ii) Will provide for or secure housing for workers who are not reasonably able to return to their permanent residence at the end of the work day that complies with the applicable local, State. or Federal standards and guidelines for housing without charge to the worker; Where required. has timely requested a preoccupancy inspection of the housing and received certi?cation; (iv) Will provide insurance. without charge to the worker. under a State workers' compensation law or otherwise. that meets the requirements of 20 CFR provide transportation in compliance with all applicable Federal, State or local laws and regulations between the worker's living quarters housing provided by the employer under 20 CFR and the employer's worksite without cost to the worker. 9. The employer has not laid off and will not lay off any similarly employed U.S. worker in the occupation that is the subject of the Application for Temporary Empiovment Certification in the area of intended employment except for lawful, job related reasons within 60 days of the date of need. or if the employer has iaid off such Workers. it has offered the job opportunity that is the subject of the application to those laid-off U.S. worker(s) and the US. workerfs) refused the job opportunity. was rejected for the job opportunity for lawful. job-related reasons. or was hired. 10. The employer and its agents have not sought or received payment of any kind from the worker for any activity related to obtaining labor certi?cation. including payment of the employer?s attorneys' fees. application fees. or recruitment costs. For purposes of this paragraph. payment includes. but is not limited to. monetary payments. wage concessions (including deductions from wages. salary. or benefits). kickbacks. bribes. tributes. in kind payments. and free labor. 11. The employer has and will contractually forbid any foreign labor contractor or recruiter whom the employer engages in international recruitment of H-2A workers to seek or receive payments from prospective 12. The employer has not and will not intimidate. threaten, restrain. coerce. blacklist, or in any manner discriminate against. and has not and will not cause any person to intimidate. threaten. restrain. coerce. blacklist. or in any manner discriminate against. any person who has with just cause: Filed a complaint under or related to Sec. 218 of the INA (8 U.S.C. 1188). or any Department regulation promulgated under Sec. 218 of the (ii) Instituted or caused to be instituted any proceeding under or related to Sec. 218 of the INA. or any Department regulation promulgated under Sec. 218 of the Testified or is about to testify in any proceeding under or related to Sec. 218 of the INA or any Department regulation promulgated under Sec. 218 of the (iv) Consulted with an employee of a iegal assistance program or an attorney on matters related to Sec. 218 of the INA or any Department regulation promulgated under Sec. 218 of the or Exercised or asserted on behalf of himself/herself or others any right or protection afforded by Sec. 218 of the INA, or any Department regulation promulgated under Sec. 218 of the INA. 13. The employer has not and will not discharge any person because of that person's taking any action listed in paragraph 12(i) through listed above. 14. The employer will inform H-2A workers of the requirement that they leave the US. at the end of the period certified by the Department or separation from the employer, whichever is earlier. as required under 20 CFR 655.1350). unless the H-2A worker is being sponsored by another subsequent employer. 15. The employer has posted the Notice of Workers? Rights as required by 20 CFR 655.135?) in a conspicuous place frequented by all employees. 16. If the application is being ?led as an H-2A Labor Contractor the following additional attestations and obligations apply under 20 CFR 655.132: The H-2A Labor Contractor has provided a copy of the MSPA Farm Labor Contractor (FLC) certi?cate of registration if required under MSPA. 1801 U.S.C. et seq. to have such a certificate identifying the specific farm labor contracting activities it is authorized to perform; (ii) The H-2A Labor Contractor has provided with this application a list of the names and locations of each fixed-site agricultural business to which the H-2A Labor Contractor expects to provide workers. the expected beginning and ending dates when the H-2A Labor Coptractor will be providing the workers to each fixed site. a description of the crops and activities the workers are expected to perform at such ?xed site. and copies of the fully-executed work contracts with each fixed-site agricultural business so identi?ed; 7 The H-2A Labor Contractor is able to provide proof of its ability to discharge ?nancial obligations under the program and has secured a surety bond as required by 29 CFR 501.9. the original of which is attached and shows the name. address. phone number. and contact person for the surety. and provides the amount of the bond (as calculated pursuant to 29 CFR 501.9); ETA Form 9I42 Appendix A2 FOR DEPARTMENT OF LABOR USE ONLY Page A.2 ofA.3 Case Case Staning C?b Period of Employment: to I I OMB Approval: 1205-0466 Expiration Date: 11/30/2011 Application for Temporary Employment Certification ETA Form 9142 APPENDIX A.2 US. Department of Labor (iv) The H-2A Labor Contractor has engaged in and will engage in recruitment efforts in each area of intended employment in which it has listed a ?xed-site agricultural business as required in 20 CFR 655.121, 655.150-155; and Where the ?xed-site agricultural business(es) will provide housing or transportation to the workers, proof that: a. All housing used by workers and owned, operated. or secured by the ?xed-site agricultural business complies with the applicable housing standards in 20 CFR b. All transportation between the worksite and the workers? living quarters that is provided by the fixed-site agricultural business complies with all applicable Federal, State, or local laws and regulations and that it will provide, at a minimum, the same vehicle safety standards, driver licensure, and vehicle insurance as required under 29 U.S.C. 1841 and 29 CFR part 500, except where workers' compensation is used to cover such transportation as described in and c. Certificates of occupancy from the SWA for all employer owned housing and copies of all drivers? licenses, vehicle registration, and insurance policies for all drivers and vehicles used to transport H-2A workers. I hereby acknowledge that the agent or attorney identified in section (if any) of the ETA Form 9142 and section A above is authorized to represent me for the purpose of labor certification and, by virtue of my signature in Block 5 below, I take full responsibility for the accuracy of any representations made by my agent or attorney. I declare under penalty of perjury that I have read and reviewed this application and that to the best of my knowledge the information contained therein is true and accurate. understand that to knowingly furnish 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 a $250,000 fine or 5 years in the Federal penitentiary or both (18 U. 8.0. 1001). . 1. Last (family) name 2. First (given) name 3. Middle initial Williams LaTerri 4. Title Director of Human Resources 5. nature 6. Date signed l/ 2t I Ir 0MB Paperwork Reduction Act Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Respondent?s reply to these reporting requirements is mandatory to obtain the benefits of temporary emptoyment certi?cation (Immigration and Nationality Act, Section Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate to the Of?ce of Foreign Labor Certification US. Department of Labor Room C4312 200 Constitution Ave, NW Washington, DC 20210. Do NOT send the completed application to this address. ETA Form 9 I 42 Appendix A2 FOR DEPARTMENT OF LABOR USE ONLY Page A3 ofA.3 Case NumberC? liq/Case Status: Period of Employment: i to i i I