OMB Approval: Expiration Date: 03/31/2016333111/30/2011 U.S. Department of Labor Please read and review the filing instructions carefully before completing the . 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. For conve nie nce and compat ibility for al l scree n rea de rs, the use r will be prompte d for a re quire d quest ion again in eac h fie ld in a ddition to the a sterisk. A. Employment-Based Nonimmigrant Visa Information 1. Indicate the type of visa classification supported by this application (Write classification symbol): * Requ ir ed Field B. Temporary Need Information 1. Job Title * Required F ield 2. SOC (ONET/OES) code * 3. SOC (ONET/OES) occupation title * Requir ed F ield Requir ed F ield Period of Intended Employment 4. Is this a full-time position? * Requir ed Field ✔ Yes 5. Begin Date *  No 6. End Date * Required Field 7. Worker positions needed/basis for the visa classification supported by this application Required Field (mm/dd/yyyy) (mm/dd/yyyy) Total Worker Positions Being Requested for Certification * Requir ed Field Basis for the visa classification supported by this application (indicate the total workers in each applicable category based on the total workers identified above) a. New employment * b. Continuation of previously approved employment * without change with the same employer Required Field Required F ield c. Change in previously approved employment * d. New concurrent employment * e. Change in employer * f. Amended petition * Requir ed F ield Requir ed Field Required Field Required Field 8. Nature of Temporary Need: (Choose only one of the standards) * Required F ield  Peakload ✔ Seasonal 9. Statement of Temporary Need *  One-Time Occurrence  Intermittent or Other Temporary Need Required Field ETA Form 9142B Case Number: ______________________ FOR DEPARTMENT OF LABOR USE ONLY Case Status: __________________ Validity Period: ______________ to _______________ OMB Approval: Expiration Date: 03/31/2016 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 * Required Field 2. Trade name/Doing Business As (DBA), if applicable 3. Address 1 * Required F ield 4. Address 2 5. City * 6. State * Required Field 8. Country * 7. Postal code * Required Field 9. Province Requir ed F ield 10. Telephone number * Required Field 11. Extension Requir ed Field 12. Federal Employer Identification Number (FEIN from IRS) * Required F ield 13. NAICS code (must be at least 4-digits) * Requir ed Field 14. Number of non-family full-time equivalent employees 15. Annual gross revenue 16. Year established 17. Type of employer application (choose only one box below) * Required Field ✔  Individual Employer  Association – Sole Employer (H-2A only)  Association – Joint Employer (H-2A only)  Association – Filing as Agent (H-2A only)  H-2A Labor Contractor or Job Contractor 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, enter only the contact information for the main or primary employer (e.g., contact for an association filing as joint employer) under the application. 1. Contact’s last (family) name * Requir ed F ield 2. First (given) name * 3. Middle name(s) * Requir ed Field Required Field 4. Contact’s job title * Required Field 5. Address 1 * Required F ield 6. Address 2 7. City * 8. State * Required Field 10. Country * Required Field ETA Form 9142B 13. Extension 14. E-Mail address FOR DEPARTMENT OF LABOR USE ONLY Case Number: ______________________ Required Field Required Field 12. Telephone number * 9. Postal code * 11. Province Required Field Case Status: __________________ Validity Period: ______________ to _______________ OMB Approval: Expiration Date: 03/31/2016 U.S. Department of Labor 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  Yes (including associations acting as agent under the H-2A program)? If “Yes”, complete Section E. * 3. First (given) name § 4. Middle name(s) § 2. Attorney or Agent’s last (family) name § Required Field  No ✔ 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 * Required F ield 2. Number of hours of work per week _____ Basic *: __ 3. Hourly Work Schedule * Requir ed Field(Basic Hour s) Required Fiel d : ____ A.M. (h:mm): ___ Overtime: _______ 4. Does this position supervise the work of other employees? *  Yes ✔  No Required Fiel d : __ __ P.M. (h:mm): ___ 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. * Required Fi eld ETA Form 9142B FOR DEPARTMENT OF LABOR USE ONLY Case Number: ______________________ Case Status: __________________ Validity Period: ______________ to _______________ OMB Approval: Expiration Date: 03/31/2016 U.S. Department of Labor F. Job Offer Information (continued) b. Minimum Job Requirements 1. Education: minimum U.S. diploma/degree required * Required Fiel d ✔  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/ 1b. Indicate the major(s) and/or field(s) of study required § (May list more than one related major and more than one field) degree required § 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 § Required Fiel d 3. Is training for the job opportunity required? *  Yes Required Fi eld ✔ 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 § 4. Is employment experience required? * 4a. If “Yes” in question 4, specify the number of months of experience required § (May list more than one related field and more than one type)  Yes Required Fi eld ✔ No 4b. Indicate the occupation required § 5. Special Requirements - List specific skills, licenses/certifications, and requirements of the job opportunity. * Required Fiel d ! " # $ %% & '( % c. Place of Employment Information 1. Worksite address 1 * Required Fi eld 2. Address 2 3. City * 4. County * Required Fiel d Required Fi eld 5. State/District/Territory * 6. Postal code * Required Fiel d Required Fi eld 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 specificity as possible. If necessary, submit an attachment to continue and complete a listing of all anticipated worksites. § Required Fi eld ETA Form 9142B FOR DEPARTMENT OF LABOR USE ONLY Case Number: ______________________ Case Status: __________________ Validity Period: ______________ to _______________ OMB Approval: Expiration Date: 03/31/2016 U.S. Department of Labor G. Rate of Pay 1. Basic Rate of Pay Offered * 1a. Overtime Rate of Pay (if applicable) § Required Fi eld From: $ _____ . ____ To (Optional): $ _____ . ____ From: $ _____ . ____ To (Optional): $ _____ . ____ 2. Per: (Choose only one) * Required Field ✔  Hour  Week  Bi-Weekly  Month  Year  Piece Rate 2a. If Piece Rate is indicated in question 2, specify the wage offer requirements: § 3. Additional Wage Information (e.g., multiple worksite applications, itinerant work, or other special procedures). If necessary, add attachment to continue and complete description. § !" #$% #&'() * + "" , -./01% " + / 2) " + " + "" % 3 % + " 2 ) !"" ) 4 ) H. Recruitment Information 1. Name of State Workforce Agency (SWA) serving the area of intended employment * Required Fiel d 2. SWA job order identification number * 2a. Start date of SWA job order * 2b. End date of SWA job order * Required Fi eld Required Fi eld 3. Is there a Sunday edition of a newspaper (of general circulation) in the area of intended employment? * Name of Newspaper/Publication (in area of intended employment for H-2B only) * 4. From: Required Fi eld (In H-2A this date is 50% of contract period) ✔ Yes Required Fi eld 5. Dates of Print Advertisement § To: From:  No To: 6. Additional Recruitment Activities for H-2B program. Use the space below to identify the type(s) or source(s) of recruitment, geographic location(s) of recruitment, and the date(s) on which recruitment was conducted. If necessary, add attachment to continue and complete description. * Required Fi eld ETA Form 9142B FOR DEPARTMENT OF LABOR USE ONLY Case Number: ______________________ Case Status: __________________ Validity Period: ______________ to _______________ OMB Approval: Expiration Date: 03/31/2016 U.S. Department of Labor I. 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 or Appendix B 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. §  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. § ✔ Yes  No  N/A J. 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 initial § 4. Job Title § 5. Firm/Business name § 6. E-Mail address § K. 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 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 certification is valid from _______________________ to _______________________. ______________________________ Determination Date (date signed) ______________________________________________ Department of Labor, Office of Foreign Labor Certification ______________________________ Case Status ______________________________________________ Case number L. Public Burden Statement !" # $ # % # # $ & ' () * + # , - . / 0 # 1 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. ETA Form 9142B FOR DEPARTMENT OF LABOR USE ONLY Case Number: ______________________ Case Status: __________________ Validity Period: ______________ to _______________ OMB Approval: Expiration Date: 03/31/2016 U.S. Department of Labor ADDENDUM ! " !""# $ % $ & ' ( ) * + ) , , $ % - . $ $ $ +!/ $ $ 0 1 ) +!/ $ 2 ) $ ) ) $ ' +!/ 3 1 ( * ' % FOR DEPARTMENT OF LABOR USE ONLY Case Number: ______________________ Case Status: __________________ Validity Period: ______________ to _______________ OMB Approval: Expiration Date: 03/31/2016 U.S. Department of Labor ADDENDUM ! ! " ! ! # $ % & ' ! $ $ ( $ ) $ ( # *+ , - ) . ) ) ) - ! ! ! / 0/1 ! 2 34 4 ! 4 ! 25/63 /7 # / ! " ! 87$ 9:69;** 70 # 2 *: 3 ! 2 :; 3 ! ! ! 2 6 3 / ! ) < 69 4 =:6:; ! / /! > / 8 7 -7> ) 6 6 / - 6 ) ) -?1' .$7@7. 7& $$7 ?>> 7?A . $> # ! ! 1 8 FOR DEPARTMENT OF LABOR USE ONLY Case Number: ______________________ Case Status: __________________ Validity Period: ______________ to _______________ OMB Approval: Expiration Date: 03/31/2016 U.S. Department of Labor ADDENDUM ! " # FOR DEPARTMENT OF LABOR USE ONLY Case Number: ______________________ Case Status: __________________ Validity Period: ______________ to _______________ OMB Approval: Expiration Date: 03/31/2016 U.S. Department of Labor ADDENDUM ! " ! !" # $ % & ' # ()(*)!+*, ,)-)!+*, $ # & . /0 '1 ,)!)!+*, & . / '1 ,)2)!+*, $ ' *! . $ * ) # FOR DEPARTMENT OF LABOR USE ONLY Case Number: ______________________ Case Status: __________________ Validity Period: ______________ to _______________ 20% &RQWURO 1XPEHU ([SLUDWLRQ 'DWH H-2B Application for Temporary Employment Certification ETA Form 9142B – APPENDIX B U.S. Department of Labor For Use in Filing Applications Under the H-2B Non-Agricultural Program ONLY A. Attorney or Agent Declaration I hereby certify that I am an employee of, or hired by, the employer listed in Section C of the ETA Form 9142B, and that I have been designated by that employer to act on its behalf in connection with this application. I also 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 U.S.C. 1001). 1. Attorney or Agent’s last (family) name 2. First (given) name Wright Ashley 3. Middle initial 4. Firm/Business name Laobor Consultants International 5. E-Mail address ashley@laborci.com 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 bona fide, full-time temporary position, the qualifications for which are consistent with the normal and accepted qualifications required by non-H-2B employers in the same or comparable occupations. 2. The job opportunity is not vacant because the former occupant(s) is (are) on strike or locked out in the course of a labor dispute involving a work stoppage. 3. The job opportunity is open to any qualified U.S. worker regardless of race, color, national origin, age, sex, religion, handicap, or citizenship, and the employer has conducted 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 certification is sought. Any U.S. 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. 4. The offered terms and working conditions of the job opportunity are normal to workers similarly employed in the area(s) of intended employment and are not less favorable than those offered to the foreign worker(s) and are not less than the minimum terms and conditions required by Federal regulation at 20 CFR 655, Subpart A. 5. The offered wage equals or exceeds the highest of the most recent prevailing wage that is or will be issued by the Department to the employer for the time period the work is performed, or the applicable Federal, State, or local minimum wage, and the employer will pay the offered wage. 6. The offered wage is not based on commissions, bonuses or other incentives, unless the employer guarantees a wage paid on a weekly, bi-weekly, or monthly basis that equals or exceeds the prevailing wage, or the legal Federal or State minimum wage, whichever is highest. 7. During the period of employment that is the subject of the labor certification application, the employer will comply with applicable Federal, State and local employment-related laws and regulations, including employment-related health and safety laws; 8. 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 Employment Certification in the area of intended employment within the period beginning 120 days before the date of need, except where the employer also attests that it offered the job opportunity that is the subject of the application to those laid-off U.S. worker(s) and the U.S. worker(s) either refused the job opportunity or was rejected for the job opportunity for lawful, job-related reasons. ETA Form 9142B – Appendix B FOR DEPARTMENT OF LABOR USE ONLY Page B.1 of B.2 H-400-14122-284265 Case Status: __________________ Case Number:___________________ Period of Employment: ______________ to _______________ 20% &RQWURO 1XPEHU ([SLUDWLRQ 'DWH H-2B Application for Temporary Employment Certification ETA Form 9142B – APPENDIX B U.S. Department of Labor 9. The employer and its agents and/or attorneys have not sought or received payment of any kind from the employee for any activity related to obtaining labor certification, 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. 10. Unless the H-2B worker is being sponsored by another subsequent employer, the employer will inform H-2B workers of the requirement that they leave the U.S. at the end of the period certified by the Department or separation from the employer, whichever is earlier, as required under § 655.35, and that if dismissed by the employer prior to the end of the period, the employer is liable for return transportation. 11. Upon the separation from employment of any foreign worker(s) employed under the labor certification application, if such separation occurs prior to the end date of the employment specified in the application, the employer will notify the Department and DHS in writing or any other method specified of the separation from employment not later than forty-eight (48) hours after such separation is discovered by the employer. 12. The employer will not place any H-2B workers employed pursuant to this application outside the area of intended employment listed on the Application for Temporary Employment Certification unless the employer has obtained a new temporary labor certification from the Department. 13. The dates of temporary need, reason(s) for temporary need, and number of worker positions being requested for certification have been truly and accurately stated on the application. 14. If the application is being filed as a job contractor, the employer will not place any H-2B workers employed pursuant to the labor certification application with any other employer or at another employer’s worksite unless: (i) (ii) The employer applicant first makes a bona fide inquiry as to whether the other employer has displaced or intends to displace a similarly employed U.S. worker within the area of intended employment within the period beginning 120 days before and throughout the entire placement of the H-2B worker, the other employer provides written confirmation that it has not so displaced and does not intend to displace such U.S. workers; and All worksites are listed on the certified Application for Temporary Employment Certification I hereby designate the agent or attorney identified in section D (if any) of the ETA Form 9142B to represent me for the purpose of labor certification and, by virtue of my signature in Block 3 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. I 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.S.C. 1001). 1. Last (family) name 2. First (given) name Wadsworth Owen 3. Middle initial 4. Title General Manager 5. Signature 6. Date signed !" # $ # % # # $ & ' () * + # , - . / 0 # 1 2 3 / 4 - . 5 3 4 6 /78 4 00 / + # *9# 4 9 # 5/ 4 0 0 :&+ 23/ 2 ; ETA Form 9142B – Appendix B FOR DEPARTMENT OF LABOR USE ONLY Page B.2 of B.2 H-400-14122-284265 Case Status: Case Number:___________________ __________________ Period of Employment: ______________ to _______________