U.S. DEPARTMENT OF LABOR
EMPLOYMENT AND TRAINING ADMINISTRATION
APPLICATION FOR ALIEN EMPLOYMENT CERTIFICATION
OMB Approval No. 1205-0015 Expires: 01/31/2011
PART B. STATEMENT OF QUALIFICATIONS OF ALIEN
FOR ADVICE CONCERNING REQUIREMENTS FOR ALIEN EMPLOYMENT CERTIFICATION: If the alien is in the U.S., contact nearest office of
the United States Citizenship and Immigration Service. If the alien is outside the U.S., contact nearest U.S. Consulate.
IMPORTANT: READ ATTACHED INSTRUCTIONS BEFORE COMPLETING THIS FORM.
Print legibly in ink or use a typewriter. If you need more space to fully answer any questions on this form, use a separate sheet. Identify
each answer with the number of the corresponding question. Sign and date each sheet.
1. Name of Alien (Family name in capital letters) First name Middle name Maiden name
2. Present Address (No., Street, City and Town, State or Province and ZIP code) Country
3. Type of Visa (If in U.S.)
4. Alien’s Birth date
(Month, Day, Year)
5. Birthplace (City or Town, State or Province) Country
6. Present Nationality or
7. Address in the United States Where Alien Will Reside
8. Name and Address of Prospective E