OMB Approval: 1205-0509 Expiration Date: 03/31/2016; I I I H-ZB Application for Temporary Employment Certification ETA Form 91423 U.S. Department of Labor Please read and review th ?ling instructions carefully before completing the ETA Form 91423. A copy of the instructions can be found at nlabo cert.doleta. ov/. In accordance with Federal Regulations, incomplete or obviously inaccurate applications will not be certified by th Department of Labor. lf submitting this form non-electronically, ALI: required ?elds/items containing an asterisk must be com leted as well as any fields/items where a response is conditional as indicated by the section symbol. Pt. Employment-Based Nonimmigrant Visa Information 1. Indicate the type of visa classi?cation supported by this application (Write classification symbol): H-ZB B. Temporary Need ln?ormation 1' J?b me Landscape Laborers 2. SOC bode 3. SOC occupation title 37-3011 Landscaping and Groundskeeping Workers 4. is this a full-time pobition? Period of Intended Employment yes No 5. Begin Date I 6. End Date 03/15 2013 (mm/Mm) 12/31/2013 7. Worker positions needed/basis for the visa classi?cation supported by this application 25 Total Wiprker Positions Being Requested for Certification Basis for the visa supported by this application (indicate the total wo I ers in each applicable category based on the total workers identi?ed above) 25 a. New employment 0 d. New concurrent employment 0 b. Conti' uation of previously approved employment 3. Change in employer witho It change with the same employer 0 0. Change in previously approved employment 0 Amended petition 8. Nature of Temporary Need: (Choose only one of the standards) Seasonal Peakload One?Time Occurrence Intermittent or Other Temporary Need 9. Statement of Tempc_rary Need SEE ADDENDUM ETA Form 91423 FOR DEPARTMENT OF LABOR USE ONLY Page 1 8 Case Number: HAM-13035718408 Case Status: Full Certi?cation Validity Period. 0311512013 to 12/31/2013 I OMB Approval: 1205-0509 Expiration Date: 03/31/2016, . . . . . H-ZB Application for Temporary Employment Certification ETA Form 91428 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. Forjoint employer or aster applications ?led 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 identi?es each employer, by namel mailigg address, and total worker positions needed, under the application. - 1. Legal business name PURE FOREST, LLC. ?Zr/grade name/Doing Business As (DBA), if applicable 3. Address 1 i 70E 2125 SOUTH 4. Addressz 5. Cit 6. State* 7. Postal code* OAKL ID 83346 8. Count 9. Province UNITED AMERICA IA 10. Telephone numbeir* 11. Extension 208?431-8777 12. Federal Employerildenti?cation Number (FEIN from 13. NAICS code (must be at least 4-digits) 56173 14. Number of non-farinin full-time equivalent employees 15. Annual gross revenue 16. Year established 2009 17. Type of employeriapplication (choose only one box below) lndivid al Employer DAssociation Sole Employer (H-ZA only) [3 H-2A LEbor Contractor or EIAssociation Joint Employer (H-2A only) Job 001 tractor DAssociation Filing as Agent (H-2A only) D. Employer Point of dontact 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 celrti?cation matters. The information in this Section [nu?st pg different from the agent or attorney information listed in Section E. unless the at orney is an employee of the employer. Forjoint employer or master applications ?led on behalf of more than one employer under the H-2 program. enter o_n y the contact information for the main or primary employer contact for an association ?ling as joint employer) unde the application. 1. Contact's last (family) name 2. First (given) name 3. Middle name(s) WADSWORTH OWEN 4. Contact?s job title Manager . 5. Address 1 7 70E 2125 SOUTH i 6. Address 2 I 7. Ci 5 8. State* 9. Postal code* OAKL - ID 83346 10. Cou nt 11. Province OH AMERICA 12. Telephone number* 13. Extension 14. E-Mail address 208-431-8777 5 ETA Form 914213 FOR DEPARTMENT OF LABOR USE ONLY Page 2 Case Number: ?40043035138403 Case Status: Full Certi?cation Validity Period: 0311512013 to 1213112013 OMB Approval: 1205-0509 Expiration Date: 03/31/2016? I H-ZB Application for Temporary Employment Certification ETA Form 91428 U.S. 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 Yes l?l No (including associations acting as age_nt under the H-2A program)? If ?Yes?, complete Section E. 2. Attorney or Agent?s last (family) name 3- First (given) name 4- Middle nameIS) LEONEL DE CERVAINTES SAYDE MARISOL 5. Address 1 5127 MARSH LANE) 6. Address 2 I MA I 7. City 8. State 5 9. Postal code BUDA TX 78610 10. Count 11. Province UNITED TES OF AMERICA IA 12. Telephone number? 13. Extension 14. E-Maii address 512-740-5256 3 15. Law firm/Busines name 16. Law firm/Business FEIN INFINITY LABOR URCE, INC. 17. State Bar number (oniy if attorney) 18. State of highest court where attorney is in good I A . standing (only if attorney) . 19. Name of the highest court where attorney is in good standing (only if attorney) 3 F. Job Offer Informatiqn a. Job Description I 1. Job Title Landscape Laborersi 2. Number of hours of Iwork per week 3. Hourly Work Schedule Basic *1 40 Overtime: AM. 00 PM. 00 4. Does this position sIupervise the work of other employees? 4a. If yes, number of employees : YesNo worker will supervise (if applicable)? 5. Job duties A des ription of the duties to be performed MUST begin in this space. If necessary, add attachment to continue and complete description. Will landscape or maintain grounds of property using hand or power tools or equipment. ETA Form 914213 FOR DEPARTMENT OF LABOR USE ONLY 3 "5 case Number; Case Status; Full Certi?cation Vaiidl?ty period; 03/15/2013 to 12/31/2013 OMB Approval: 1205-0509 Expiration Date: 03/31/2016; I I I . H-2B Application for Temporary Employment Certification ETA Form 91428 U.S. Department of Labor F. Job Offer lnfon'nation (continued) b. Minimum Job Requirements 1. Education: minimuin U.S. diploma/degree required None High Schdol/GED Associate?s DBachelor's DMaster's DDoctorate 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 tist more than one related major and more than one ?eld) i 2. Does the employer require a second U.S. diploma/degree? MI No 2a. If "Yes" in question 2, indicate the second U.S. diploma/degree and the major(s) and/or ?eld(s) of study required 3. Is training for the job opportunity required? Yes No 3a. if ?Yes? in question 3, specify the number of 3b. Indicate the of training required months of training req Jired (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 4b. Indicate the occupation required 5 months of experience required i 5. Special Requirements - List specific skills, licenses/certifications, and requirements of the job opportunity. 5 c. Place of Employment Information 1. Worksite address Multipie JObSlteS Withth 2. Address 2 3. City 4. County Hayfork i Trinity 5. StatelDistrictlTerritory 6. Postal code CA 96041 7. Will work be performed in multiple worksites within an area of intended employment or a Iopation(s) other than the address listed abovequestion 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. SEE ADDENDUM FOR ADDITIONAL WORKSITE FOR PLACE OF EMPLOYMENT ETA Form 91423 FOR DEPARTMENT OF LABOR USE ONLY Page 4 0f 9 Case Number. H-4oo-13035-7i'a408 Case Status; Full Certi?cation Validity Period: 03/15/2013 to 12/31/2013 OMB Approval: 1205-0509 Expiration Date: 03/31/20161 . . . H-ZB Application for Temporary Employment Certification ETA Form 91423 U.S. Department of Labor G. Rate of Pay 1. Basic Rate of Pay bffered 1a. Overtime Rate of Pay (ifapplr'cable) From: 9 To (Optional): From: 38 To (Optional):$ . 2. Per: (Choose only one)* Hour El Week Bi-Weekly DMonth DYear '3 Piece Rate 2a. If Piece Rate is indicated in question 2, specify the wage offer requirements: 3. Additional Wage In ormation multiple worksite applications, itinerant work, or other special procedures). If necessary, add achment to continue and complete description. H. Recruitment Information 1. Name of State Worltforce Agency (SWA) serving the area of intended employment California Department of Labor 2. SWA job order identi?cation number 2a. Start date of SWAjob order 2b. End date of SWA job order (In H-2A this date is 50% of contract period) CA13723705 01/11/2013 01/21/2013 3. Is there a Sunday edition of a newspaper (of general circulation) in the area of I intended employme nt? Yes I [No Name of Newspaper/ Publication (in area ofintended employment forH?ZB only) Dates of Print Advertisement 4. From: To: Times Standard . 01/13/2013 01/16/2013 5. ?3 From: To: 6. Additional Recruitnient Activities for H-ZB 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. California 1 CA Department of Labor Job Order Times Standard 1 ETA Form 91423 FOR DEPARTMENT OF LABOR USE ONLY Page 5 8 case Number; H-400?13035-7i8408 Case Status; Full Certi?cation Validity period; 03/15/2013 to 12/31/2013 i i 0MB Approval: 1205-0509 Expiration Date: 03/31/2016i . . H-2B Application for Temporary Employment Certification 5 ETA Form 91423 i U.S. Department of Labor i I. Declaration of and AttorneyIAgent in accordance with Fed: ral regulations, the employer must attest that it will abide by certain terms, assurances and obligations as a condition for recei ing a temporary labor certi?cation from the U.S. Department of Labor. Applications that fail to attach Appendix A or Appendix will be considered incomplete and not accepted for orocessincr bv the ETA a lication rocessin mtg. i 1. For H-ZA Applicati ins ONLY, please con?rm that you have read and agree to all the applicable terms, assu rances and obligations contained in Appendix A. : Yes El No I: 2. For H-ZB Applications ONLY, please confirm that you have read and agree to all the applicable terms, assurances and obligations contained in Appendix Preparer Complete this section if t1he preparer of this application is a person other than the one identi?ed in either Section (employer point of contact) or (a orney or agent) of this application. 1. Last (family) namel? 2. First (given) name 5 3. Middle initial 4. Job Title 5. Firm/Business nanie 6. E-Mailaddress? K. u.s. Government Agency Use (ONLY) Pursuant to the provisio is of Section 101 of the Immigration and Nationality Act, as amended, I hereby certify that there are not suf?cient S. workers available and the employment of the above will not adversely affect the wages and working conditions of workers in he U.S. similarly employed. By virtue of the signature below, the Department of Labor hereby acknowledges the following: This certi?cation is valild from 03/ 1 5/201 3 to 12/31/2013 .57 02/19/2013 Department of Labor, (pf?ce of Foreign Labor Certi?cation Determination Date (date signed) H4oo-13035-7384q8 Full Certification Case number Case Status L. Public Burden Statement (1205-0509) Persons are not required to espond to this collection of information unless it displays a currently valid OMB control number. Public reporting burden for this collection of nformation is estimated to average 1.5 hours to complete the form and 25 minutes per response for all other H-2B information collection requir ments, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and compl ting and reviewing the collection of information. The obligation to respond to this data collection is required to obtain/retain bene?ts (lmmi ration and Nationality Act, 8 U.S.C. 1101, et seq.) Please send comments regarding this burden estimate or any other aspect of this informat collection to the Of?ce of Foreign Labor Certi?cation U.S. Department of Labor Room C4312 200 Constitution Ave., NW. Wa hington, DC 20210 or by email Please do not send the completed application to this address. i i ETA Form 91423 - FOR DEPARTMENT OF LABOR USE ONLY Page 6 of 3 Case Number: Case Status: Fuuceni?cation Validity Period: 03?15?2013 to 1251/2013 OMB Approval: 1205-0509 Expiration Date: 03131/2016i I . I 1 H-ZB Application for Temporary Employment Certification ETA Form 91428 U.S. Department of Labor ADDENDUM ADDENDUM SECTION 8.9: Additional Notes Regarding Statement of Temporary Need Pure Forest has helped landow-1ers acquire and improve timberland to meet goals as unique as their properties. We are full-service land management specialists, able to assess the needs of our clients before deveioping and implementing successful forest rovides andowners with the advantages they need to make the most of investment, recreationa and personal opportunities. . Currently we do not have a full staff to handle the upsurge our seasonal need. Our seasonal need starts in March each year during Spring and it continues through December. ure Forest helps our clients undergo the process of forest ct rti?cation for their land to consider for both environmental and ?nancial reasons. The process entails a number of steps that. when complete, demonstrate that they are following sustainable forestry management practices. Not only is forest certification good for the environment. but it can also be ?nancially advantageous for private landowners of forest land. Pure Forest has helped numerous clients become certi?ed. ETA Form 91423 - FOR DEPARTMENT OF LABOR USE ONLY Page 7 ?f 8 Case Number: HAW-13035338403 Case Status: Validity Period: 0311512013 to 12/31/2013 OMB Approval: 1205-0509 Expiration Date: 03/31/2016: H-ZB Application for Temporary Employment Certification ETA Form 91428 U.S. Department of Labor ADDENDUM ADDENDUM SECTION F.c.7: Additional Worksites 1. . 2. California County/Township RINITY - NORTHERN MOUNTAINS REGION OF CALIFORNIA NONMETROPOLITAN AREA 3. California EHAMA - NORTH VALLEYREGION OF CALIFORNIA NONMETROPOLITAN AR EA ETA Form 91423 FOR DEPARTMENT OF LABOR USE ONLY Page 8 0? 5 Case Number: H400-13035-75I3403 Case Status: Validity Period: 03/15/2013 to 1213112013 OMB Control Number. 1205l?0509 Expiration Date: 03/31/2016} i H-ZB Application for Temporary Employment Certification ETA Form 91428 APPENDIX US Department of Labor Fior Use in Filing Applications Under the H-ZB Non-Agricultural Program ONLY A. Attorney or Agent beclaration lhereby certify that [am an employee of, or hired by, the employer listed in Section of the ETA Form 91423, and that have been designated by I at 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 ?ne or 5 years in a Fedeial penitentiary or both (18 U.S.C. 1001 1. Attorney or Age wt?s last (family) name LEONEL DE CERVANTES 3. Middle initial MARISOL 2. First (given) name SAYDE 4. Firm/Business mame INFINITY LABOR SOURCE, INC. 5. E-Mail address 6. Signature 7. Date signed B. Employer Declaration By virtue of my signature below, I HEREBY following conditions of employment: 1. The job opportE nity is a bona ?de, full-time temporary position, the quali?cations for which are consistent with the normal and accepted quali _Ications required by non-H-ZB employers in the same or comparable occupations. The job opport: nity is not vacant because the former occupant(s) is (are) on strike or locked out in the course of a labor dispute involvi a work stoppage. The job opportcillnity is open to any quali?ed U.S. worker regardless of race, color, national origin, age, sex, religion, handicap, or citizenship. an the employer has conducted the required recruitment, in accordance with regulations, and has been unsuccessful in locating suf?ci nt numbers of quali?ed U.S. applicants for the job opportunity for which certi?cation is sought. Any US. workers who applied or applet for the job were or will be rejected only for lawful, job-related reasons, and the employer must retain records of all rejections. intended empl ment and are not less favorable than those offered to the fereign worker(s) and are not less than the minimum The offered ter: 3 and working conditions of the job opportunity are normal to workers similarly employed in the area(s) of terms and con _itions required by Federal regulation at 20 CFR 655, Subpart A. to the employe for the time period the work is performed, or the applicable Federal, State, or local minimum wage, and the The offered wate equals or exceeds the highest of the most recent prevailing wage that is or will be issued by the Department employer will the offered wage. a weekly, bi-w ekly, or basis that equals or exceeds the prevailing wage, or the legal Federal or State minimum wage. The offered wa? is not based on commissions, bonuses or other incentives. unless the employer guarantees a wage paid on hest. whichever is hi During the period of employment that is the subject of the labor certi?cation application, the employer will comply with applicable Federal, State and local employment-related laws and regulations, including employment-related health and safety laws; The employer as not laid off and will not lay off any similarly employed U.S. worker in the occupation that is the subject of the A lication for em ora Em Io ment Certi?cation 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 applicati0n to ose laid-off U.S. worker(s) and the US. worker(s) either refused the job opportunity or was rejected for the job opportunity for awful, job-related reasons. ETA Form 914213 Appendix Case Number: FWD-13033438408 Case Status: Full Certi?cation FOR DEPARTMENT OF LABOR USE ONLY Page 13.1 of B2 Period of Employment: 03/15/2013 to 12/31/2013 OMB Control Number: 120510509 Expiration Date: 03/3 1/201'6t H-ZB Application for Temporary Employment Certification ETA Form 91423 US. 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 certi?cation, including payment of the employer's attorneys' fees, application fees, or recruitment core. For purposes of this paragraph, payment includes, but is not limited to, monetary payments, wage concessions (i cluding deductions from wages, salary, or bene?ts), kickbacks, bribes, tributes, in kind payments, and free labor. 10. Unless the H-ZB worker is being sponsored by another subsequent employer, the employer will inform H-ZB workers of the requirement th they leave the US. at the end ofthe period certi?ed by the Department or separation from the employer. whichever is rlier. as required under 655.35, and that if dismissed by the employer prior to the end of the period, the employer is lialple for return transportation. 11. Upon the separation from employment of any foreign worker(s) employed under the labor certi?cation application. if such separation occl?Jrs prior to the end date of the employment speci?ed in the application, the employer will notify the Department and DHS in wr: ing or any other method speci?ed of the separation from employment not later than forty-eight (48) hours after such separatioh is discovered by the employer. 12. The employer Will not place any H-ZB workers employed pursuant to this application outside the area of intended employment listed on the Application for Temporary Employment Certi?cation unless the employer has obtained a new temporary labor certi?cation froin the Department. 13. The dates of teinporary need, reason(s) for temporary need, and number of worker positions being requested for certi?cation have been truly and accurately stated on the application. 14. lfthe applicati is being ?led as a job contractor, the employer will not place any H-ZB workers employed pursuant to the labor certi?cati application with any other employer or at another employer's worksite unless: The Employer applicant ?rst makes a bona ?de inquiry as to whether the other employer has displaced or intends to dispi ce 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-ZB worker, the other employer provides written con? mation that it has not so displaced and does not intend to displace such U.S. workers; and (ii) All erksites are listed on the certi?ed Application for Temporary Employment Certification I hereby designate thi agent or attorney identi?ed in section (if any) of the ETA Form 91423 to represent me for the purpose of labor certi?cation and, by vi ue 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 penalt of perjury that have read and reviewed this application and that to the best of my knowledge the information contained therein is tru and accurate. I understand that to knowingly furnish false information in the preparation of this form and any supplement thereto or t' aid, abet, or counsel another to do so is a felony punishable by a $250,000 ?ne or 5 years in the Federal penitentiary or both (18 I .S.C. 1001). 1. Last (family) naniie 2. First (given) name 3. Middle initial WADSWORTH OWEN 4. Title Manager 5. Signature 6. Date signed Public Burden Statemlent (1205-0509) Persons are not required respond to this collection of information unless it displays a currently valid OMB control number. Public reporting burden for this collection information is estimated to average 1.5 hours to complete the form and 25 minutes per response for all other H-ZB information collection reqttirements, 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 bene?ts (lm igration and Nationality Act, 8 U.S.C. 1101, et seq.) Please send comments regarding this burden estimate or any other aspect of this collection to the Of?ce of Foreign Labor Certi?cation U.S. Department of Labor Room C4312 200 Constitution Ave., NW, Washington, DC 20210 or by email ETA.OFLC.Forms@doI.gov. Please do not send the completed application to this address. ETA Form 91423 Appendix FOR DEPARTMENT OF LABOR USE ONLY Page B2 of B2 Case Number; 1303SF73 8408 Case Status; Full Certi?cation Period of 03/15/2013 to 12/31/2013