Form ETA-9089 – Appendix A FOR DEPARTMENT OF LABOR USE ONLY Page A.1 of A.5 PERM Case Number: __________________ Case Status: _________________ Determination Date: _____________ Expiration Date: _____________

When submitting the form to USCIS, please sign and submit a fully executed copy of page 2 along with Form ETA-9089 and the appropriate appendices. PERM applications submitted to OFLC will receive an electronic version of this form if the application is certified.

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Form ETA-9089 – Appendix A FOR DEPARTMENT OF LABOR USE ONLY Page A.2 of A.5 PERM Case Number: __________________ Case Status: _________________ Determination Date: _____________ Expiration Date: _____________

Form ETA-9141 – Appendix A, Request for Additional Worksite(s) U.S. Department of Labor . Important Note: Identify any additional worksite(s) for which the employer is requesting issuance of an additional prevailing wage. Additional Worksite 1 . County/State or BLS Area (Metropolitan or Non-Metropolitan Statistical Areas) Name * 1.

For applications submitted by mail, the Form ETA-9089, Form ETA- 9089 – General Instructions, and Appendices A to D, are available to be downloaded from the Office of Foreign Labor Certification at http://www.foreignlaborcert.doleta.gov.

Application for Temporary Employment Certification (Form ETA-9142A) and all required appendices; and Additional documentation for H-2A Labor Contractors and agents. Where to Apply

1. Appendix A is the Foreign Worker’s information, which consists of the foreign worker’s contact information, education, qualifications, skills, abilities and proficiencies, and work experience. The employer can go directly to Appendix A by selecting the “Go to …

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).

on the approved Form ETA-9089, including all appendices, offered by the employer if granted a visa or an adjustment of status based on this permanent labor certification.