OMB Approval No. 1205-0015 Expires: 01/31/2011
U.S. DEPARTMENT OF LABOR
Employment and Training Administration
APPLICATION
FOR
ALIEN EMPLOYMENT CERTIFICATION
IMPORTANT: READ CAREFULLY BEFORE COMPLETING THIS FORM
PRINT legibly in ink or use a typewriter. If you need more space to
answer questions in this form, use a separate sheet. Identify each answer
with the number of the corresponding question. SIGN AND DATE each
sheet in original signature.
To knowingly furnish any false information in the preparation of this form
and any supplemental thereto or to aid, abet, or counsel another to do so is
a felony punishable by $10,000 fine or 5 years in the penitentiary, or both
(18 U.S.C. 1001)
PART A. OFFER OF EMPLOYMENT
1. Name of Alien (Family name in capital letter, First, Middle, Maiden)
2. Present Address of Alien (Number, Street, City and Town, State ZIP code or Province, Country)
3. Type of Visa (if in U.S.)
The following information is submitted as an offer of employment
4. Name of Employer (Full name of Organization) | 5. Federal Taxpayer ID -- EIN
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