Michael A. Pezzuto
Attorney at Law
(805) 604-9555
Labor Certification Questionnaire
This questionnaire should be filled out completely and accurately. If you do not understand a question or have any other problem regarding any of the items, please feel free to call (805) 604-9555 or
email us your question(s).
1. The name of the alien:
Tel No.:
E-mail address:
2. U.S. current address of alien:
Social Security No.:
3. Foreign address of alien:
4. Date of Birth:
Place of Birth:
5. Present Nationality or Country of Citizenship:
6. Status in the U.S.A.:
Expiration Date:
Address:
Name of person within the company who will be the contact person for coordination of the recruitment phase and newspaper ad approval:
Full Name:
E-mail:
8. Telephone of employer (area code and number):
9. Fax No.:
10. Does employer have a Web page?
11. If the address where the alien will work is different from item # 7(A), give address:
12. Annual sales or income of employer’s organization:
Note: A copy of the employer’s federal income tax return or annual report must be submitted to the Immigration & Naturalization Service when an immigrant petition is filed.
(b) Total number of employees in the employer’s organization:
(c) Employer’s Federal Tax Identification No.:
(d) Date business established:
13. Give brief non-technical description of the nature of the employer’s business or activity:
14. How many other employees will the alien supervise?
15. Give number of employees at the place where the alien will work:
16. Exact job title of the job being offered to the alien:
17. (a) Total basic hours per week that the alien will work:
(b) Work schedule hours from:
(c) Total overtime hours per week that the alien will work:
18. What is the basic rate of pay per hour, week, or month:
19. List Licenses: (Professional, Journeymen, etc.):
20.What is the occupational title of the person who will be the alien’s immediate supervisor:
21. Full name and title of person signing the job offer for the alien:
Name:
Title:
Tel No:
Fax No:
22. Are there Multiple Openings:
How Many:
IF THE BUSINESS IS A RESTAURANT:
(a) What are the business hours?
(b) How many days are you open per week?
Name those days:
Seating capacity:
SUMMARY OF ALIEN WORKER’S EDUCATIONAL QUALIFICATIONS:
(Attach photocopies of degree and transcripts)
Can you produce your degree?
Can you produce your transcripts?
Have you ever had your foreign educational awards evaluated by a professional U.S. credentials evaluator?
1. Name and address of school, college or university attended:
Field of study: Degree/Diploma or Certificate obtained:
Academic years: From(Mo./Yr.):
Yo (Mo./Yr.):
4. Qualifications and skills you possess
(Please include proficiency with computer languages, use of equipment, tools and/or machines; and/or experience with special procedures and or techniques):