OMB Approval: 1205-0509
Expiration Date: 333111/30/2011
12/31/2018

H-2B Application for Temporary Employment Certification
ETA Form 9142B
U.S. Department of Labor

Please read and review the filing instructions carefully before completing the ETA Form 9142B . 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

H-2B

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 *

VENDOR

Required F ield

2. SOC (ONET/OES) code *

3. SOC (ONET/OES) occupation title *

41-9091

Door-to-Door Sales Workers, News and Street Vendors, and Related Workers

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 * 02/15/2016

 No

6. End Date *

Required Field

7. Worker positions needed/basis for the visa classification supported by this application

40

10/31/2016

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)

40

a. New employment *

0

b. Continuation of previously approved employment *
without change with the same employer

0

Required Field

Required F ield

c. Change in previously approved employment *

0

d. New concurrent employment *

0

e. Change in employer *

0

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

 Seasonal
✔ Peakload
9. Statement of Temporary Need *

 One-Time Occurrence

 Intermittent or Other Temporary Need

Required Field

SEE ADDENDUM
La Costenita Distribuidor, Inc. dba La Super Michoacana is a company located in Austin, Texas focused in the
outdoors sale of frozen ice cream. La Super Michoacana was founded in 2008 and has gross annual revenues of
approximately $1.5 million.
La Super Michoacana has a temporary peakload need for vendors from 02/15/2016 to 10/31/2016. This peakload
need is tied to a season of the year with warmest months. The vendor's duties include selling frozen ice cream
from a mobile vending cart and occasionally assist in the preparation of the ice cream product.
The need for these vendors is essential for the continuation of the business. La Super Michoacana focuses its
sales on South and Central Austin, and with the continuous growth of the population in Austin, La Super
Michoacana recently expanded its sales routes to a third region, North Austin. Consequently the company is
requesting the total of forty (40) vendors to handle multiple routes

ETA Form 9142B
H-400-15307-676510
Case Number: ______________________

FOR DEPARTMENT OF LABOR USE ONLY
CERTIFIED
Case Status: __________________

Page 1 of 8

02/15/2016
10/31/2016
Validity Period: ______________
to _______________

 OMB Approval: 1205-0509
Expiration Date: 12/31/2018

H-2B Application for Temporary Employment Certification
ETA Form 9142B
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

La Costenita Distribuidor
2. Trade name/Doing Business As (DBA), if applicable

La Super Michoacana
3. Address 1 *

Required F ield

2002 E. 4th Street
4. Address 2

N/A

5. City *

Austin

6. State *

Required Field

8. Country *

7. Postal code *

Required Field

TX

9. Province

Requir ed F ield

UNITED STATES OF AMERICA

N/A

512-481-1332

N/A

10. Telephone number *

Required Field

78702

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

311520

14. Number of non-family full-time equivalent employees

15. Annual gross revenue

16. Year established

2008

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

Jose

Alvarado

C

4. Contact’s job title *

Owner

Required Field

5. Address 1 *

Required F ield

2002 E. 4th Street
6. Address 2

N/A

7. City *

Austin

8. State *

TX

Required Field

10. Country *

12. Telephone number *

Required Field

512-481-1332

ETA Form 9142B

Required Field

11. Province

13. Extension

14. E-Mail address

N/A

lacostenita2008@gmail.com

FOR DEPARTMENT OF LABOR USE ONLY

H-400-15307-676510
Case Number: ______________________

9. Postal code *

78702

N/A

Required Field

UNITED STATES OF AMERICA

Required Field

Case Status: __________________
CERTIFIED

Page 2 of 8

02/15/2016
10/31/2016
Validity Period: ______________
to _______________

 OMB Approval: 1205-0509
Expiration Date: 12/31/2018

H-2B Application for Temporary Employment Certification
ETA Form 9142B
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

CRISTINA

ZAMBRANO

✔

 No

N/A

5. Address 1 §

2720 BEE CAVES ROAD
6. Address 2

N/A

7. City §

8. State §

AUSTIN

TX

UNITED STATES OF AMERICA

N/A

10. Country §

9. Postal code §

78746

11. Province

12. Telephone number §

13. Extension

14. E-Mail address

512-732-0555

N/A

CRISTINA@ALGVISAS.COM

15. Law firm/Business name §

16. Law firm/Business FEIN §

AZARMEHR LAW GROUP

17. State Bar number (only if attorney) §

18. State of highest court where attorney is in good
standing (only if attorney) §

24079625

TEXAS

19. Name of the highest court where attorney is in good standing (only if attorney) §

SUPREME COURT
F. Job Offer Information
a. Job Description
1. Job Title *

VENDOR

Required F ield

2. Number of hours of work per week

40_____
Basic *: __

3. Hourly Work Schedule *

Requir ed Field(Basic Hour s)

Required Fiel d

10
Overtime: _______

00
6 : ____
A.M. (h:mm): ___

4. Does this position supervise the work of other employees? *
 Yes ✔
 No
Required Fiel d

P.M. (h:mm): ___
00__
9 : __

4a. If yes, number of employees
N/A
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

Duties include: Selling frozen ice cream from a mobile vending cart and occasionally assist in the preparation of
the ice cream product, which includes but is not necessarily exclusively limited to securing and mixing ice cream
product ingredients.
Employee must work outdoors and must stand or walk for eight hour shifts, taking breaks as needed.
*Overtime: Number of hours will vary from 0-10 hours per week

ETA Form 9142B

FOR DEPARTMENT OF LABOR USE ONLY

H-400-15307-676510
Case Number: ______________________

Case Status: __________________
CERTIFIED

Page 3 of 8

02/15/2016
10/31/2016
Validity Period: ______________
to _______________

 OMB Approval: 1205-0509
Expiration Date: 12/31/2018

H-2B Application for Temporary Employment Certification
ETA Form 9142B
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 §

n/a

n/a

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

N/A
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 §

N/A

N/A

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

N/A

✔ No

4b. Indicate the occupation required §

N/A

5. Special Requirements - List specific skills, licenses/certifications, and requirements of the job opportunity. *

Required Fiel d

n/a

c. Place of Employment Information
1. Worksite address 1 *

2002 E. 4th Street

Required Fi eld

2. Address 2

N/A

3. City *

4. County *

Austin

Travis

Required Fiel d

Required Fi eld

5. State/District/Territory *

TX

6. Postal code *

Required Fiel d

78702

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

State
Area Based On
Area
1. Texas County/Township TRAVIS - AUSTIN-ROUND ROCK, TX MSA
2. Texas County/Township WILLIAMSON - AUSTIN-ROUND ROCK, TX MSA

ETA Form 9142B

FOR DEPARTMENT OF LABOR USE ONLY

H-400-15307-676510
Case Number: ______________________

CERTIFIED
Case Status: __________________

Page 4 of 8

10/31/2016
02/15/2016
Validity Period: ______________
to _______________

 OMB Approval: 1205-0509
Expiration Date: 12/31/2018

H-2B Application for Temporary Employment Certification
ETA Form 9142B
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:

57
11
$ _____
. ____

To (Optional):

N/A . ____
N/A
$ _____

From:

17
36
$ _____
. ____

To (Optional):

0
0
$ _____
. ____

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: §

N/A

3. Additional Wage Information (e.g., multiple worksite applications, itinerant work, or other special procedures).
If necessary, add attachment to continue and complete description. §

SEE ADDENDUM
Multiple locations within the same MSA. Includes Travis and Williamson Counties.

H. Recruitment Information
1. Name of State Workforce Agency (SWA) serving the area of intended employment *

Required Fiel d

N/A

2. SWA job order identification number *

2a. Start date of SWA job order *

2b. End date of SWA job order *

N/A

N/A

N/A

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

 No

Required Fi eld

N/A

N/A

N/A

N/A

5.

From:

Dates of Print Advertisement §
To:

N/A
To:

N/A

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

N/A

ETA Form 9142B

FOR DEPARTMENT OF LABOR USE ONLY

H-400-15307-676510
Case Number: ______________________

Case Status: __________________
CERTIFIED

Page 5 of 8

10/31/2016
02/15/2016
Validity Period: ______________
to _______________

 OMB Approval: 1205-0509
Expiration Date: 12/31/2018

H-2B Application for Temporary Employment Certification
ETA Form 9142B
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 §

Zambrano

Cristina

N/A

4. Job Title §

Attorney

5. Firm/Business name §

Azarmehr Law Group
6. E-Mail address §

cristina@algvisas.com
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:

10/31/2016
02/15/2016
This certification is valid from _______________________
to _______________________.

02/02/2016
______________________________
Determination Date (date signed)

______________________________________________
Department of Labor, Office of Foreign Labor Certification

H-400-15307-676510

______________________________
CERTIFIED
Case Status

______________________________________________
Case number
L. Public Burden Statement (1205-0509)

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 1 hour to complete the form, 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.
Please do not send the completed application to this address.

ETA Form 9142B

FOR DEPARTMENT OF LABOR USE ONLY

H-400-15307-676510
Case Number: ______________________

Case Status: __________________
CERTIFIED

Page 6 of 8

10/31/2016
02/15/2016
Validity Period: ______________
to _______________

 OMB Approval: 1205-0509
Expiration Date: 12/31/2018

H-2B Application for Temporary Employment Certification
ETA Form 9142B
U.S. Department of Labor

ADDENDUM

ADDENDUM SECTION B.9: Additional Notes Regarding Statement of Temporary Need
in the entire city of Austin. Once the peak season is over, we do not anticipate needing this large staff of vendors. After the temporary period is over, the company anticipates that its regular
workforce of permanent employees will be sufficient to handle the company's workload. La Super Michoacana has undergone recruitment for temporary vendors for the past several years;
it has been through the H-2B Program that they have been able to find qualified temporary workers to supplement their permanent labor force.
Please find attached payroll records for years 2014 and 2015 (as up-to-date as possible). Please note our need for forty (40) temporary workers is temporary and our peakload is from
February 15 to October 31.

ETA Form 9142B

FOR DEPARTMENT OF LABOR USE ONLY

H-400-15307-676510
Case Number: ______________________

CERTIFIED
Case Status: __________________

Page 7 of 8

02/15/2016
10/31/2016
Validity Period: ______________
to _______________

 OMB Approval: 1205-0509
Expiration Date: 12/31/2018

H-2B Application for Temporary Employment Certification
ETA Form 9142B
U.S. Department of Labor

ADDENDUM

ADDENDUM SECTION G.3: Additional Notes Regarding Wage Information
*Overtime is paid at time and a half of the hourly base rate for work over 40 hours per week.
**In addition to the hourly wage specified above, all vendors are eligible to receive additional wage as an incentive for weekly gross sales that exceed minimum expectations.

ETA Form 9142B

FOR DEPARTMENT OF LABOR USE ONLY

H-400-15307-676510
Case Number: ______________________

CERTIFIED
Case Status: __________________

Page 8 of 8

02/15/2016
10/31/2016
Validity Period: ______________
to _______________