Form ETA9033-A "Employers' Attestation to Use Alien Crewmembers for Longshore Activities in the State of Alaska"

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Download Form ETA9033-A "Employers' Attestation to Use Alien Crewmembers for Longshore Activities in the State of Alaska"

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OMB No. 1205-0309
Employers’ Attestation to Use Alien Crewmembers for
Expiration Date: 01/31/2020
Longshore Activities in the State of Alaska
Form ETA 9033-A
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(s) and Job Information at Location(s) in the State of Alaska
Complete this section for each location in the State of Alaska. Use attachments if additional space is needed or multiple
locations are covered.
1. Name of Port and City
2. Begin date of performance of the first activity by the
3. Is the employer submitting this form less than 30
alien crewmember
days from the first date of need?
(mm/dd/yyyy)
 Yes
 No
(If “Yes”, include documentation to show that employer could
not have reasonably anticipated the need to file an attestation
for location in C.1. at that time.)
4. Total number of crewmembers being requested
5. Identify the longshore 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
6. Enter job qualifications required to perform each activity identified in C.5
Form ETA 9033-A
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 the State of Alaska
Form ETA 9033-A
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(s) and Job Information at Location(s) in the State of Alaska
Complete this section for each location in the State of Alaska. Use attachments if additional space is needed or multiple
locations are covered.
1. Name of Port and City
2. Begin date of performance of the first activity by the
3. Is the employer submitting this form less than 30
alien crewmember
days from the first date of need?
(mm/dd/yyyy)
 Yes
 No
(If “Yes”, include documentation to show that employer could
not have reasonably anticipated the need to file an attestation
for location in C.1. at that time.)
4. Total number of crewmembers being requested
5. Identify the longshore 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
6. Enter job qualifications required to perform each activity identified in C.5
Form ETA 9033-A
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 the State of Alaska
Form ETA 9033-A
U.S. Department of Labor
D. Employer Attestation
1.
Before using alien crewmen to perform any longshore activity, the employer will make a bona fide request to the
parties to whom notice has been provided under Item 4(ii) and (iii) below, for U.S. longshore workers who are
qualified and available in sufficient numbers to perform the longshore activities at the particular time and
location, except that:
(i) whenever two or more contract stevedoring companies have signed a joint collective bargaining
agreement with a labor organization described in Item 4(i) below, the request for longshore workers
may be made to only one such stevedoring company, and
(ii) a request for longshore workers to any operator of a private dock may be made only for longshore
work to be performed at that dock and only if the operator meets the requirements of Section 32 of
the Longshore and Harbor Workers’ Compensation Act.
2.
During the validity period of this attestation, the employer will employ all U.S. longshore workers made available
in response to the request for dispatch as attested in Item 1 above and who are qualified, available in sufficient
numbers, and are needed to perform the longshore activity at the particular time and location.
3.
The employer’s use of alien crewmembers in any employ to perform any longshore activity is not intended or
designed to influence an election of a bargaining representative for workers in the State of Alaska.
4.
As of this date, the employer has provided notice of this attestation in compliance with 20 CFR 655.537(a)(1) to
(include copies of notices):
(i) Labor organizations which have been recognized as exclusive bargaining representatives of the
U.S. longshore workers and which make available or intend to make available longshore workers to
the particular location(s) where the longshore work is to be performed;
(ii) Contract stevedoring companies which employ or intend to employ U.S. longshore workers at the
particular location(s) where the longshore work is to be performed; and
(iii) Operators of private docks at which workers will perform any longshore activity.
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
Department of Labor, Office of Foreign Labor Certification
Acceptance Date (date signed)
Case number
Case Status
Form ETA 9033-A
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 the State of Alaska
Form ETA 9033-A
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-A. In accordance with Federal Regulations, incomplete or obviously inaccurate applications
will not be accepted by the Department of Labor.
Submit the completed original Form ETA 9033-A with accompanying documentation along with two copies of the form and accompanying
documentation. Attestation must be received by the Department of Labor no later than 30 days prior to the first performance of the longshore activity
(or anytime up to 24 hours before the first performance on the activity upon a showing that the employer could not have reasonably anticipated the
need to file an attestation for that location at the time). Attestations which are filed less than 30 days prior to the first performance of the longshore
activity must include supporting documentation to show that the employer could not have reasonably anticipated the need to file attestation for that
location at that time. 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. An employer may file a single attestation for multiple locations in the
State of Alaska.
Anyone, who knowingly and willingly furnishes any false information in the preparation of Form ETA 9033-A 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(s) and Job Information in State of Alaska
1.
Enter the full legal name of a business, firm or organization, or if an
Employer may file a single Form ETA 9033-A for multiple locations in
individual, enter name used for legal purposes on documents.
the State of Alaska. Use attachments if additional space is needed.
2.
Enter the full trade name or “Doing Business As” (DBA) name, if
1.
Enter the name of the port(s), and the city(ies) in the State of
applicable, of the business, person, association, firm, corporation, or
Alaska in which the port is located.
organization, i.e., the employer filing this application.
2.
Enter the date of the first performance of the longshore activity.
3.
Enter the street address of the employer’s principal place of
3.
Check appropriate box if claiming an unanticipated need.
business.
4.
Enter an estimate of the total number of crewmembers that the
4.
If additional space is needed for the street address, use this line to
employer anticipates requesting for the activity specified for this
complete the employer’s street address.
attestation.
5.
Enter the city of the employer’s principal place of business. If the city
5.
Longshore work is defined as activity relating to (1) loading of
and country are the same, the name must still be entered in both
cargo, (2) unloading of cargo, (3) operation of cargo-related
fields.
equipment, and (4) handling of mooring lines on the dock when a
6.
Enter the state of the employer’s principal place of business.
vessel is made fast or let go. The employer must check each
7.
Enter the postal (zip) code of the employer’s principal place of
activity it intends to perform.
business.
6.
Provide the qualifications required to perform each of the job(s)
8.
Enter the country of the employer’s principal place of business.
identified in C.5.
9.
Enter the province of the employer’s principal place of business, if
applicable.
Section D. Employer Attestation
10. Enter the area code and telephone number for the employer’s
See 20 CFR § 655.534 through 655.537 of the regulations for guidance
principal place of business. Include country code, if applicable.
on the documentation that must be developed and maintained to meet
11. Enter the e-mail address of the employer point of contact in the
the employer’s burden of proof under the attestation elements.
format name@emailaddress.top-level domain.
1.
Bona Fide Request for Dispatch of U.S. Longshore Workers.
12. Enter name of the employer point of contact. An employer point of
The employer must attest that, before using alien crewmen to
contact is an employee of the employer whose position authorizes
perform longshore work, it will make a bona fide request for the
the employee to provide information and supporting documentation
U.S. longshore workers who are qualified and available in
concerning this Employer’s Attestation to Use Alien Crewmembers
sufficient numbers to perform the activity at the particular times
for Longshore Activities in the State of Alaska and to communicate
and locations specified. The request for dispatch must be directed
with the Department of Labor on behalf of the employer. The
to the parties to whom notice of filing is provided under attestation
employer point of contact should be the individual most familiar with
element D.4 (ii) and (iii). Wherever two and more contract
the content of this application and circumstances of the foreign
stevedoring companies have signed a joint collective bargaining
worker’s employment.
agreement with a labor organization described in attestation
13. Enter the job title of the employer point of contact.
element D.1 (i), the employer may request longshore workers from
only one of such contract stevedoring company. A request for
Section B. Employer’s U.S. Agent or Representative Information
longshore workers to an operator of a private dock may be made
(if applicable)
only for longshore work to be performed at that dock and only if the
Note: The U.S. agent/representative information in this Section,
operator meets the requirements of section 32 of the Longshore
specifically the name, telephone number, and e-mail address, must be
and Harbor Workers’ Compensation Act (33 U.S.C. 932). See §
different from the employer point of contact information in Section A.
655.534 of the regulations for a detailed explanation of this
1.
Enter the full name of the agent/representative.
attestation element.
2.
Enter the street address of the attorney/agent (address must be a
2.
Employment of U.S. Longshore Workers.
The employer must
U.S. address).
attest that all U.S. longshore workers made available in response
3.
Enter the city of the attorney/agent.
to the request for dispatch under the first attestation element, item
4.
Enter the state of the attorney/agent.
D.1, who are qualified and available in sufficient number and who
5.
Enter the postal (zip) code of the attorney/agent.
are needed to perform the longshore activity at the particular times
6.
Enter the area code and telephone number of the attorney/agent.
and locations specified will be employed to perform such activity.
7.
Enter the extension of the telephone number of the attorney/agent, if
See § 655.535 of the regulations for a detailed explanation of this
applicable.
attestation element.
8.
Enter the e-mail address of the attorney/agent in the format
name@emailaddress.top-level domain.
Form ETA 9033-A
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 the State of Alaska
Form ETA 9033-A
U.S. Department of Labor
3.
No Intention or Design to Influence Bargaining Representative
locations, and to operators of private docks at which the employer
Election.
The employer must attest that its use of alien
will use longshore workers. The copy of such notices must be
crewmembers to perform longshore activities is not intended or
submitted to ETA along with the Form ETA 9033-A. The notice
must comply with 20 CFR 655.537(a)(2).
designed to influence an election for a bargaining representative
for longshore workers in the State of Alaska. See § 655.536 of the
regulations for detailed explanation of this attestation element.
Section E. Declaration of Employer
4.
Notice of Filing. The employer must attest that at the time of filing
One copy of this form must bear the original signature of employer or
the attestation, notice of filing has been provided to labor
the employer’s designated agent or representative unless filing by
organizations which have been recognized as exclusive bargaining
facsimile transmission. See §655.532(a) of the regulations if filing by
representatives of U.S. longshore workers and which make
facsimile transmission. By signing this form, the chief executive officer
available or intend to make available workers to the particular
is attesting to the conditions listed in item D. 1 through 4 and to the
locations where the longshore work is to be performed. Notice
accuracy of the information provided elsewhere on the form and in
must also be provided to contract stevedoring companies which
supporting documentation. False statements are subject to federal
employ or intend to employ U.S. longshore workers at those
criminal penalties, as stated above.
If the attestation bears the necessary entries of information and includes required supporting documentation, the Department of Labor will accept the
attestation for filing and shall document such acceptance on each of the three Form ETA 9033-A submitted. The Department will provide a copy of
the accepted attestation to the Department of Homeland Security office having jurisdiction over the port where the longshore work will be performed
by alien crewmen. A copy of the attestation indicating the Department’s acceptance will be provided 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. If the employer’s attestation is not accepted
because it is incomplete or inaccurate, the Department will return the attestation to the employer.
A copy of this attestation, along with accompanying documentation, will be available for public inspection at the Office of Foreign Labor Certification,
200 Constitution Avenue, N.W., Room C4312, 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 currently valid OMB
OMB Public Burden Statement -
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 3 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, Box 12-200, 200 Constitution Avenue, N.W., Washington, D.C. 20210 (OMB control
Number 1205-0309).
Form ETA 9033-A
Page 4 of 4
FOR DEPARTMENT OF LABOR USE ONLY
Case Number: ________________
Case Status: __________________Validity Period: ______________ to _______________
Page of 4