PERM Prefiling Questionnaire | The Messersmith Law Firm, P.A.

Intake / ETA-9089

Contact and foreign worker identity

Administrative contact information and beneficiary identity for the office. Beneficiary identity is also covered by Form ETA-9089 Appendix A.

Foreign worker first (given) name*

Foreign worker last (family) name*

Email address for correspondence*

Preferred telephone number

A / ETA-9089

Employer information

ETA-9089 Section A, items 1–17

Legal business name

Trade name / Doing Business As (DBA), if applicable

Employer address line 1

Employer address line 2 / suite

Employer city

Employer state

Employer postal code

Employer country

Employer province, if applicable

Employer telephone number

Telephone extension

Federal Employer Identification Number (FEIN)

NAICS code

Current employees on payroll in area of intended employment

Year commenced business (or year issued FEIN for household)

Does the foreign worker own an interest in a closely held corporation, partnership, or sole proprietorship employer?

Is the foreign worker related to the employer’s owners, stockholders, partners, corporate officers, or incorporators?

B / ETA-9089

Employer point of contact

ETA-9089 Section B, items 1–14; authorized employee of the employer, not outside counsel unless counsel is an employee.

Employer contact last (family) name

Employer contact first (given) name

Employer contact middle name(s)

Employer contact job title

Contact address line 1

Contact address line 2 / suite

Contact city

Contact state

Contact postal code

Contact country

Contact province, if applicable

Contact telephone number

Contact telephone extension

Contact business email address

E / ETA-9089

Job opportunity and wage

ETA-9089 Section E, items 1–5

Offered wage — From (USD)

Offered wage — To (USD), if applicable

Offered wage period

Additional conditions about offered wage

F.a / ETA-9089

Worksite location

ETA-9089 Section F.a, items 1–8a

Type of worksite location

Worksite street address

Worksite suite / floor / unit

Worksite city

Worksite county

Worksite state, district, or territory

Worksite postal code

MSA/OES area code

MSA name / OES area title

F.b–c / ETA-9089

Additional worksites and geographic coverage

ETA-9089 Sections F.b–F.c

Will work be performed in other geographic areas?

Other definable geographic area(s) in which work will be performed

G / ETA-9089

Additional job requirements and disclosures

ETA-9089 Section G, including all nested conditional items

Is the position permanent, full-time employment of 35 hours or more?

Is this a live-in household domestic service worker position?

If G.2 yes, does the worker have one year of paid live-in domestic service experience?

If G.2 yes, have employer and worker executed the required work contract?

If G.2b yes, did the employer give the worker a copy of the contract?

Will employer accept a foreign diploma or degree equivalent to the required US degree in the PWD?

Is the foreign worker currently working for the petitioning employer?

If currently employed, does the worker qualify only through the employer’s alternative requirements?

If G.4 and G.4a are yes, will the employer accept any suitable combination of education, experience, or training?

Is the employer relying solely on experience gained by the worker while employed by that employer?

If G.5 yes, was the qualifying experience gained in a substantially comparable position?

If G.5 yes, did employer pay for education/training required for the offered job?

Does job opportunity require worker to live on employer premises?

Does the job combine occupations?

Is proficiency in a foreign language required or preferred?

Do requirements exceed the occupational O*NET Job Zone SVP level?

Did employer use credentialing service to qualify worker education or experience?

Has employer received any payment for submitting this application?

Were there relevant layoffs in the past six months in the area of intended employment?

H.a–b / ETA-9089

Proposed job category

ETA-9089 Section H.a item 1 (page 4) and Section H.b item 1a–1e (page 5)

Intended occupation category

Appendix A.1 / ETA-9089

Appendix A · Foreign worker identity

Foreign worker information for ETA-9089 Appendix A, page A.1.

Last (family) name

First (given) name

Middle name(s)

Current street address 1

Current address 2 / suite

Current city

State

Postal code

Country

Province

Date of birth

Class of admission

Alien Registration Number (A#), if applicable

Country of birth

Country of citizenship or nationality

Appendix A.2 / ETA-9089

Appendix A · Education

Provide each applicable degree or diploma in the five entries on Appendix A, pages A.1–A.2.

Education 1 — US equivalent degree or diploma

Education 1 — Other degree description

Education 1 — Major(s) and fields of study

Education 1 — Degree issuing institution

Education 1 — Institution country

Education 1 — Month/year degree attained (MM/YYYY)

Education 2 — US equivalent degree or diploma

Education 2 — Other degree description

Education 2 — Major(s) and fields of study

Education 2 — Degree issuing institution

Education 2 — Institution country

Education 2 — Month/year degree attained (MM/YYYY)

Education 3 — US equivalent degree or diploma

Education 3 — Other degree description

Education 3 — Major(s) and fields of study

Education 3 — Degree issuing institution

Education 3 — Institution country

Education 3 — Month/year degree attained (MM/YYYY)

Education 4 — US equivalent degree or diploma

Education 4 — Other degree description

Education 4 — Major(s) and fields of study

Education 4 — Degree issuing institution

Education 4 — Institution country

Education 4 — Month/year degree attained (MM/YYYY)

Education 5 — US equivalent degree or diploma

Education 5 — Other degree description

Education 5 — Major(s) and fields of study

Education 5 — Degree issuing institution

Education 5 — Institution country

Education 5 — Month/year degree attained (MM/YYYY)

Appendix A.3 / ETA-9089

Appendix A · Training and credentials

Three training/certification/license entries from Appendix A, pages A.2–A.3.

Training 1 — Institution, school or training provider

Training 1 — Training, coursework or experience received

Training 1 — Training certification/license attained

Training 1 — Start month/year (MM/YYYY)

Training 1 — End month/year (MM/YYYY)

Training 1 — Month/year awarded (MM/YYYY)

Training 2 — Institution, school or training provider

Training 2 — Training, coursework or experience received

Training 2 — Training certification/license attained

Training 2 — Start month/year (MM/YYYY)

Training 2 — End month/year (MM/YYYY)

Training 2 — Month/year awarded (MM/YYYY)

Training 3 — Institution, school or training provider

Training 3 — Training, coursework or experience received

Training 3 — Training certification/license attained

Training 3 — Start month/year (MM/YYYY)

Training 3 — End month/year (MM/YYYY)

Training 3 — Month/year awarded (MM/YYYY)

Appendix A.4 / ETA-9089

Appendix A · Skills and proficiencies

Two detailed entries for skills, abilities and proficiencies from Appendix A, pages A.3–A.4.

Skills 1 — Employer, institution, school, or training provider

Skills 1 — Country

Skills 1 — State, territory or province

Skills 1 — Description of specific skills, abilities or proficiencies (1,500 characters)

Skills 2 — Employer, institution, school, or training provider

Skills 2 — Country

Skills 2 — State, territory or province

Skills 2 — Description of specific skills, abilities or proficiencies (1,500 characters)

Appendix A.5 / ETA-9089

Appendix A · Employment history

Add one work experience record for each employer or position. Captures Appendix A, pages A.4–A.5.

Foreign worker work experience

Add an entry for each employer or position. Up to 20 work records can be included.

Appendix B / ETA-9089

Appendix B · Additional worksites

Five worksite entries from ETA-9089 Appendix B, page B.1.

Additional worksite 1 — County

Additional worksite 1 — State, district or territory

Additional worksite 1 — MSA/OES area code

Additional worksite 1 — MSA name/OES area title

Additional worksite 2 — County

Additional worksite 2 — State, district or territory

Additional worksite 2 — MSA/OES area code

Additional worksite 2 — MSA name/OES area title

Additional worksite 3 — County

Additional worksite 3 — State, district or territory

Additional worksite 3 — MSA/OES area code

Additional worksite 3 — MSA name/OES area title

Additional worksite 4 — County

Additional worksite 4 — State, district or territory

Additional worksite 4 — MSA/OES area code

Additional worksite 4 — MSA name/OES area title

Additional worksite 5 — County

Additional worksite 5 — State, district or territory

Additional worksite 5 — MSA/OES area code

Additional worksite 5 — MSA name/OES area title

Appendix C / ETA-9089

Appendix C · Supplemental explanations

Explain answers requiring supplemental information or business necessity; two Appendix C entries, page C.1.

Explanation 1 — Section and item number

Explanation 1 — Section name or category

Explanation 1 — Supplemental information / business necessity (up to 1,500 characters)

Explanation 2 — Section and item number

Explanation 2 — Section name or category

Explanation 2 — Supplemental information / business necessity (up to 1,500 characters)

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