Form ETA9033 "Employers' Attestation to Use Alien Crewmembers for Longshore Activities in U.S. Ports"

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Download Form ETA9033 "Employers' Attestation to Use Alien Crewmembers for Longshore Activities in U.S. Ports"

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OMB No. 1205-0309
Employers’ Attestation to Use Alien Crewmembers for
Expiration Date: 01/31/2020
Longshore Activities in U.S. Ports
Form ETA 9033
U.S. Department of Labor
A. Employer Information
1. Legal business name
2. Trade name/Doing Business As (DBA), if applicable
3. Address 1
4. Address 2
5. City
6. State
7. Postal code
8. Country
9. Province
10. Telephone number, including area code
11. E-mail address
12. Employer point of contact name
13. Contact’s job title
B. Employer’s U.S. Agent or Representative Information
Complete this section if the application is filed by employer’s U.S. agent or representative.
1. Name of U.S. Agent or Representative
2. U.S. Business Address
3. City
4. State
5. Postal code
6. Telephone number
7. Extension
8. E-Mail address
C. Location and Job Information
1. Name of Port, City and State
2. Begin date of performance of the first activity by the alien
3. Does employer claim an unanticipated
crewmember
emergency?
 Yes
 No
(mm/dd/yyyy)
(If “Yes”, include documentation to support claim)
4. Total number of crewmembers being requested
5. Identify activities to be performed by alien crewmembers: (Choose all that apply)
a. Loading cargo
b. Unloading cargo
c. Handling of mooring lines
d. Operation of cargo-related equipment
e. Use of automated equipment (For the automated vessel prevailing practice exception only)
Form ETA 9033
Page 1 of 4
FOR DEPARTMENT OF LABOR USE ONLY
Case Number: ________________
Case Status: __________________Validity Period: ______________ to _______________
OMB No. 1205-0309
Employers’ Attestation to Use Alien Crewmembers for
Expiration Date: 01/31/2020
Longshore Activities in U.S. Ports
Form ETA 9033
U.S. Department of Labor
A. Employer Information
1. Legal business name
2. Trade name/Doing Business As (DBA), if applicable
3. Address 1
4. Address 2
5. City
6. State
7. Postal code
8. Country
9. Province
10. Telephone number, including area code
11. E-mail address
12. Employer point of contact name
13. Contact’s job title
B. Employer’s U.S. Agent or Representative Information
Complete this section if the application is filed by employer’s U.S. agent or representative.
1. Name of U.S. Agent or Representative
2. U.S. Business Address
3. City
4. State
5. Postal code
6. Telephone number
7. Extension
8. E-Mail address
C. Location and Job Information
1. Name of Port, City and State
2. Begin date of performance of the first activity by the alien
3. Does employer claim an unanticipated
crewmember
emergency?
 Yes
 No
(mm/dd/yyyy)
(If “Yes”, include documentation to support claim)
4. Total number of crewmembers being requested
5. Identify activities to be performed by alien crewmembers: (Choose all that apply)
a. Loading cargo
b. Unloading cargo
c. Handling of mooring lines
d. Operation of cargo-related equipment
e. Use of automated equipment (For the automated vessel prevailing practice exception only)
Form ETA 9033
Page 1 of 4
FOR DEPARTMENT OF LABOR USE ONLY
Case Number: ________________
Case Status: __________________Validity Period: ______________ to _______________
OMB No. 1205-0309
Employers’ Attestation to Use Alien Crewmembers for
Expiration Date: 01/31/2020
Longshore Activities in U.S. Ports
Form ETA 9033
U.S. Department of Labor
D. Employer Attestation
As of this date, there is no collective bargaining agreement in effect in the port covering at least 30 percent of
the longshore workers.
Important Note: Employer must submit two copies of its facts and evidence to show compliance with the following three attestation
elements. If accompanying documentation supporting each one of the following attestation elements is not attached,
attestation will be deemed incomplete and will be returned without action.
1.
On the date this attestation is signed and submitted, the performance of the activity by alien crewmembers is
permitted under the prevailing practice of the port.
2.
As of this date, there is not a strike or lockout in the course of a labor dispute at this port and, during the period
of this attestation’s validity, the employer will not use alien crewmember in its employ to perform any longshore
activity during a strike or lockout; and the employment of such aliens is not intended or designed to influence an
election for a bargaining representative for longshore workers at the port.
3.
As of this date, notice of this attestation has been provided to longshore workers in the port by (check
appropriate box):
(i) Notice of this filing has been provided to the bargaining representative of longshore workers in the port
(include copy of actual notice); or
(ii) Where there is no such bargaining representative, notice of this filling has been provided to the port
authority, and to longshore workers employed at the port through posting in conspicuous locations (include
copy of actual notice posted).
E.
Declaration of Employer
Pursuant to 28 U.S.C. 1746, I declare under penalty of perjury that the information provided on this form and
accompanying documentation is true and correct. In addition, I declare that I will comply with the Department of Labor
regulations governing this program and, in particular, that I will make this attestation, supporting documentation, and
other records, files and documents available to official’s request, during any investigation under this attestation or the
Immigration and Nationality Act.
Employer Signature (or employer’s U.S. agent or
Date
representative)
F.
FOR U.S. GOVERNMENT AGENCY USE ONLY
By virtue of the signature below, the Department of Labor hereby acknowledges that this program attestation for the
longshore activities is accepted for filing. The Department of Labor is not the guarantor of the accuracy, truthfulness or
adequacy of an attestation accepted for filing.
This attestation is valid from
to
Case number
Case Status
Department of Labor, Office of Foreign Labor Certification
Acceptance Date (date signed)
Form ETA 9033
Page 2 of 4
FOR DEPARTMENT OF LABOR USE ONLY
Case Number: ________________
Case Status: __________________Validity Period: ______________ to _______________
OMB No. 1205-0309
Employers’ Attestation to Use Alien Crewmembers for
Expiration Date: 01/31/2020
Longshore Activities in U.S. Ports
Form ETA 9033
U.S. Department of Labor
GENERAL INSTRUCTIONS
IMPORTANT: Please read these instructions carefully before completing the form. These instructions contain full explanations of the questions and
attestations that make up the Form ETA 9033. In accordance with Federal Regulations, incomplete or obviously inaccurate applications will
not be accepted by the Department of Labor.
Form ETA 9033 with required accompanying documentation must be filed for each port. An employer may file an attestation only when there is no
collective bargaining agreement in effect in the local port covering at least 30 percent of the number of individuals employed in performing longshore
work. Submit the completed original Form ETA 9033 along with two copies of the form and two sets of accompanying documentation. Attestations
must be received by the Employment and Training Administration, Office of Foreign Labor Certification no later than 14 days before the first
performance of the longshore activity unless the employer is claiming an unanticipated emergency. Attestations must be submitted to the Office of
Foreign Labor Certification, Employment and Training Administration, U.S. Department of Labor, 11 West Quincy Court, Chicago, IL 60604-2105.
Anyone, who knowingly and willingly furnishes any false information in the preparation of Form ETA 9033 and any supporting documentation, or
aids, abets, or counsels another to do so is committing a federal offense, punishable by fine or imprisonment up to five years or both (18 U.S.C. §§
2, 1001). Other penalties apply as well to fraud or misuse of this immigration document and to perjury with respect to this form (18 U.S.C. §§ 1546,
1621).
Section A. Employer Information
Section C. Location and Job Information
1.
Enter full legal name of business, firm or organization, or if an
1.
Enter the name of the port, and the city and state in which the port
individual, enter name used for legal purposes on documents.
is located.
2.
Enter the full trade name or “Doing Business As” (DBA) name, if
2.
Enter the date on which the longshore activity will begin.
applicable, of the business, person, association, firm, corporation,
3.
Check appropriate box if claiming an unanticipated emergency.
or organization, i.e., the employer filing this application.
4.
Enter an estimate of the total number of crewmembers that the
3.
Enter the street address of the employer’s principal place of
employer anticipates requesting for the activity specified for this
business.
attestation.
4.
If additional space is needed for the street address, use this line to
5.
Longshore work is defined as activity relating to (1) loading of
complete the employer’s street address.
cargo, (2) unloading of cargo, (3) operation of cargo-related
5.
Enter the city of the employer’s principal place of business. If the
equipment, and (4) handling of mooring lines on the dock when a
city and country are the same, the name must still be entered in
vessel is made fast or let go. The employer must check each
both fields.
activity it intends the alien crewmembers to perform.
6.
Enter the state of the employer’s principal place of business.
7.
Enter the postal (zip) code of the employer’s principal place of
Section D. Employer Attestation
business.
An employer must attest to the conditions listed in elements 1 through 4.
8.
Enter the country of the employer’s principal place of business. If
The attestation will only be accepted for filing if the required
the city and country are the same, the name must still be entered in
documentation supporting the first three elements is attached to the
both fields.
Form ETA 9033. See §655.510(d) through (f) of the regulations for
9.
Enter the province of the employer’s principal place of business, if
guidance on the documentation that must be attached to the Form ETA
applicable.
9033 to support each of the elements.
10. Enter the area code and telephone number for the employer’s
1.
Prevailing Practice. The employer must attest that it is the
principal place of business. Include country code, if applicable.
prevailing practice to use alien crewmembers for the particular
11. Enter the e-mail address of the employer point of contact in the
activity or activities of longshore work at U.S port where the
format name@emailaddress.top-level domain.
employer intends to employ alien crewmembers.
12. Enter name of the employer point of contact. An employer point of
2.
No Strike or Lockout; No Intention or Design to Influence
contact is an employee of the employer whose position authorizes
Bargaining Representative Election. The employer must attest that,
the employee to provide information and supporting documentation
at the time of submitting the attestation, there is not a strike or
concerning this Employer’s Attestation to Use Alien Crewmembers
lockout in the course of labor dispute covering the employer’s
for Longshore Activities in U.S. Ports and to communicate with the
activity, and that it will not use alien crewmembers during a strike
Department of Labor on behalf of the employer. The employer point
or lockout after filing the attestation. The employer must also attest
of contact should be the individual most familiar with the content of
that the employment of such aliens is not intended or designed to
this application and circumstances of the foreign worker’s
influence an election for a bargaining representative for workers in
employment.
the local port.
13. Enter the job title of the employer point of contact.
3.
Notice of filing. The employer must attest that at the time of filing
the attestation, notice of filing has been provided to the bargaining
representative of the longshore workers in the local port, or, where
Section B. Employer’s U.S. Agent or Representative Information (if
there is no such bargaining representative, notice of filing has been
applicable)
Note: The U.S. agent/representative information in this Section,
provided to the port authority for distribution to the public on
specifically the name, telephone number, and e-mail address, must be
request and to the longshore workers employed at the local port
different from the employer point of contact information in Section A.
through a posting in conspicuous locations. The notice must
1.
Enter the full name of the agent/representative.
comply with the requirements of 20 CFR 655.10(f). . The employer
2.
Enter the street address of the attorney/agent (address must be a
must check the appropriate box under D.3.
U.S. address).
4.
In order to be eligible to use alien crewmembers for longshore
3.
Enter the city of the attorney/agent.
activities at a U.S. port, an employer must attest that there is no
4.
Enter the state of the attorney/agent.
collective bargaining agreement in effect in the local port covering
5.
Enter the postal (zip) code of the attorney/agent.
at least 30 percent of individuals employed in performing longshore
6.
Enter the area code and telephone number of the attorney/agent.
work. An employer is not required to submit documentation to
7.
Enter the extension of the telephone number of the attorney/agent,
support this condition.
if applicable.
8.
Enter the e-mail address of the attorney/agent.
Form ETA 9033
Page 3 of 4
FOR DEPARTMENT OF LABOR USE ONLY
Case Number: ________________
Case Status: __________________Validity Period: ______________ to _______________
OMB No. 1205-0309
Employers’ Attestation to Use Alien Crewmembers for
Expiration Date: 01/31/2020
Longshore Activities in U.S. Ports
Form ETA 9033
U.S. Department of Labor
employer’s designated agent or representative is attesting to the
E. Declaration of Employer
One copy of this form must bear the original signature of the employer
conditions listed in item D.1 through 4 and to the accuracy of the
or the employer’s designated agent or representative unless filing by
information provided elsewhere on the form and in supporting
facsimile transmission. See §655.510(c)(1) of the regulations if filing by
documentation. False statements are subject to federal criminal
facsimile transmission. By signing this form, the employer or the
penalties, as stated above.
If the attestation bears the necessary entries of information and documentation, the Certifying Officer will accept the attestation for
filing, and shall document such acceptance on each of the three Form ETA 9033 submitted. The Department will notify the office of
the Department of Homeland Security having jurisdiction over the port where longshore work will be performed of the acceptance. A
copy of the attestation form indicating the Department’s acceptance will be returned to the employer. If the attestation is not accepted
because it is incomplete or inaccurate, a notification of nonacceptance will be returned to the employer. The employer may then use
alien crewmembers for longshore work at the port for which this attestation has been accepted in accordance with the Department of
Homeland Security regulations, unless the Department subsequently acts to suspend or invalidate the attestation.
A copy of this attestation, along with accompanying documentation, will be available for public inspection at the Office of Foreign Labor
Certification, Box 12-200, 200 Constitution Avenue, N.W., Washington, D.C. 20210 or OFLC website at
http://www.foreignlaborcert.doleta.gov.
Persons are not required to respond to this collection of information unless it displays a
OMB Public Burden Statement -
currently valid OMB control number. Respondents’ obligation to reply to these reporting requirements are required to obtain or retain
benefits (8 U.S.C. 1101 et seq.) Public reporting burden for this collection of information is estimated to average 4 hours per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Office of Foreign Labor
Certification, 200 Constitution Avenue, N.W., Room C4312, Washington, D.C. 20210 (OMB Control Number 1205-0309).
Form ETA 9033
Page 4 of 4
FOR DEPARTMENT OF LABOR USE ONLY
Case Number: ________________
Case Status: __________________Validity Period: ______________ to _______________
Page of 4