Form TT-RDL-071 "Application to Employ Non-resident Worker(S) and Employer's Non-resident Worker Agreement" - Federated States of Micronesia

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Download Form TT-RDL-071 "Application to Employ Non-resident Worker(S) and Employer's Non-resident Worker Agreement" - Federated States of Micronesia

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FEDERATED STATES OF MICRONESIA
DEPARTMENT OF JUSTICE
DIVISION OF IMMIGRATION AND LABOR
Palikir, Pohnpei FM 96941
APPLICATION TO EMPLOY NON
APPLICATION TO EMPLOY NON
APPLICATION TO EMPLOY NON
APPLICATION TO EMPLOY NON- - - - RESIDENT WORKER(S)
RESIDENT WORKER(S)
RESIDENT WORKER(S)
RESIDENT WORKER(S)
AND
AND
AND
AND
EMPLOYER’S NON
EMPLOYER’S NON- - - - RESIDENT WO
EMPLOYER’S NON
EMPLOYER’S NON
RESIDENT WO
RESIDENT WO
RESIDENT WORKER AGREEMENT
RKER AGREEMENT
RKER AGREEMENT
RKER AGREEMENT
IMPORTANT: This application is limited to employment of non-resident workers in one occupational category (job classification) only.
In accordance with the provisions of Title 51, FSM Code, non-resident workers must report to work in the F.S.M. no later than sixty
(60) days after the effective date of the National Government Endorsement (see page 2).
SECTION A
SECTION A- - - - APPLICATION
SECTION A
SECTION A
APPLICATION
APPLICATION
APPLICATION
1. Name of Employer:_________________________
2. Address:_____________________________________
3. Location where alien will work (list each state if more than one):________________________________________________
4. Current Size of Organization: Annual Sales or Income$_________
No. of Resident Workers:_____________________________
No. of Non-Resident Workers:__________________________
Total No. of Employees:_____________________________
5. Foreign Business Permit No._________________________ 6. Government Contract No. (if applicable):__________________
7. State or Municipal Business Permit No.________________________________________________________________
8. Brief non-technical description of the nature of employer’s business or activity:________________________________________
_______________________________________________________________________________________
9. Exact dates you expect to employ alien(s) (Not to exceed one year):
From:________________
To:___________________
10. Job Classification:
10. Job Classification:_____________________
10. Job Classification:
10. Job Classification:
11. No. of openings to be filled:
11. No. of openings to be filled:
11. No. of openings to be filled:
11. No. of openings to be filled:__________________
12. Describe fully the job to be performed:
Duties:___________________________________________________________________________________
_______________________________________________________________________________________
13. Equipment operated:________________________
Working conditions:________________________________
14. State in detail the minimum requirements for worker to perform satisfactorily the job duties described above:
Education and Training:_________________________________________________________________________
Work Experience:____________________________________________________________________________
_______________________________________________________________________________________
Specify any other special requirements:________________________________________________________________
_______________________________________________________________________________________
15. Describe efforts you have made to fill job with a resident worker:________________________________________________
_______________________________________________________________________________________
16. What is the regularly scheduled work week and hours? Days: From________ to________. Hours: From________ to__________
17. Rate of pay:
Regular $_______________
per__________________
Overtime $ ______________
per__________________
18. Additions to basic rate of pay (commissions, price rate, etc.): __________________________________________________
_______________________________________________________________________________________
19. Employee’s salary is subject to the following deductions: Housing:________ Board:________ Transportation:_______ Other:_______
_______________________________________________________________________________
SELECTION B
SELECTION B- - - - HEAL
SELECTION B
SELECTION B
HEAL
HEAL
HEALTH SERVICES LIVING QUARTERS CLEA
TH SERVICES LIVING QUARTERS CLEA
TH SERVICES LIVING QUARTERS CLEARANC
TH SERVICES LIVING QUARTERS CLEA
RANC
RANC
RANCE E E E
When employer’s total number of non-resident workers exceeds twelve (12), this application must be accompanied by a living
quarters inspection clearance issued by the State Director of Health Services. A request for clearance should be directed to the
State Chief Sanitarian who will arrange for a physical inspection of living quarters facilities.
COPY- FSM LABOR
FEDERATED STATES OF MICRONESIA
DEPARTMENT OF JUSTICE
DIVISION OF IMMIGRATION AND LABOR
Palikir, Pohnpei FM 96941
APPLICATION TO EMPLOY NON
APPLICATION TO EMPLOY NON
APPLICATION TO EMPLOY NON
APPLICATION TO EMPLOY NON- - - - RESIDENT WORKER(S)
RESIDENT WORKER(S)
RESIDENT WORKER(S)
RESIDENT WORKER(S)
AND
AND
AND
AND
EMPLOYER’S NON
EMPLOYER’S NON- - - - RESIDENT WO
EMPLOYER’S NON
EMPLOYER’S NON
RESIDENT WO
RESIDENT WO
RESIDENT WORKER AGREEMENT
RKER AGREEMENT
RKER AGREEMENT
RKER AGREEMENT
IMPORTANT: This application is limited to employment of non-resident workers in one occupational category (job classification) only.
In accordance with the provisions of Title 51, FSM Code, non-resident workers must report to work in the F.S.M. no later than sixty
(60) days after the effective date of the National Government Endorsement (see page 2).
SECTION A
SECTION A- - - - APPLICATION
SECTION A
SECTION A
APPLICATION
APPLICATION
APPLICATION
1. Name of Employer:_________________________
2. Address:_____________________________________
3. Location where alien will work (list each state if more than one):________________________________________________
4. Current Size of Organization: Annual Sales or Income$_________
No. of Resident Workers:_____________________________
No. of Non-Resident Workers:__________________________
Total No. of Employees:_____________________________
5. Foreign Business Permit No._________________________ 6. Government Contract No. (if applicable):__________________
7. State or Municipal Business Permit No.________________________________________________________________
8. Brief non-technical description of the nature of employer’s business or activity:________________________________________
_______________________________________________________________________________________
9. Exact dates you expect to employ alien(s) (Not to exceed one year):
From:________________
To:___________________
10. Job Classification:
10. Job Classification:_____________________
10. Job Classification:
10. Job Classification:
11. No. of openings to be filled:
11. No. of openings to be filled:
11. No. of openings to be filled:
11. No. of openings to be filled:__________________
12. Describe fully the job to be performed:
Duties:___________________________________________________________________________________
_______________________________________________________________________________________
13. Equipment operated:________________________
Working conditions:________________________________
14. State in detail the minimum requirements for worker to perform satisfactorily the job duties described above:
Education and Training:_________________________________________________________________________
Work Experience:____________________________________________________________________________
_______________________________________________________________________________________
Specify any other special requirements:________________________________________________________________
_______________________________________________________________________________________
15. Describe efforts you have made to fill job with a resident worker:________________________________________________
_______________________________________________________________________________________
16. What is the regularly scheduled work week and hours? Days: From________ to________. Hours: From________ to__________
17. Rate of pay:
Regular $_______________
per__________________
Overtime $ ______________
per__________________
18. Additions to basic rate of pay (commissions, price rate, etc.): __________________________________________________
_______________________________________________________________________________________
19. Employee’s salary is subject to the following deductions: Housing:________ Board:________ Transportation:_______ Other:_______
_______________________________________________________________________________
SELECTION B
SELECTION B- - - - HEAL
SELECTION B
SELECTION B
HEAL
HEAL
HEALTH SERVICES LIVING QUARTERS CLEA
TH SERVICES LIVING QUARTERS CLEA
TH SERVICES LIVING QUARTERS CLEARANC
TH SERVICES LIVING QUARTERS CLEA
RANC
RANC
RANCE E E E
When employer’s total number of non-resident workers exceeds twelve (12), this application must be accompanied by a living
quarters inspection clearance issued by the State Director of Health Services. A request for clearance should be directed to the
State Chief Sanitarian who will arrange for a physical inspection of living quarters facilities.
COPY- FSM LABOR
SELECTION C
SELECTION C- - - - EMPLOYER’S AGREEMENT
SELECTION C
SELECTION C
EMPLOYER’S AGREEMENT
EMPLOYER’S AGREEMENT
EMPLOYER’S AGREEMENT
In consideration of being allowed to employ non-resident workers I agree and certify to the following:
(1) That the information contained in Section A is true;
(2) That non-resident workers are required immediately in the job classification stated in item 10, and they will be placed on the payroll at the
wages stated in item 17 on the date they report for work in the company for which they were hired in the Federated States of Micronesia.
(3) That I will comply with the minimum employment conditions and other requirements of Title 51, as amended, of the F.S.M. Code, and other
applicable laws, regulations, and policies of the Federated States of Micronesia and its political subdivisions;
(4) That alien workers will be employed only in the job classification stated in item 10 and will not be permitted to work in any other capacity
either under my employ or otherwise;
(5) That in keeping with the intent of the Protection of Resident Workers Act, alien workers employed under this agreement shall be utilized to
train resident workers under their supervision;
(6) That I accept full responsibility and will pay expenses for the prompt return of non-resident workers to their original point of hire at the
direction of the Governor and/or the Administrator of Labor Division, or upon termination of their employment as approved by the F.S.M.
Government; and I guarantee that their stay in the Federated States of Micronesia will result in no expense to the Government.
(7) That I will maintain the records required by Section 154 of Title 51, F.S.M.C. and will make them available to the Employment Service
Officer or the Administrator of Labor immediately upon demand.
(8) That this agreement allows me to fill the number of positions in the job classification and for the time period as specified in Section E.
(9) That forty-five days before this agreement expires, I must file a new application with the State Employment Service Officer who will attempt
to fill the position with a qualified resident worker; and,
(10) That I will submit to the State Employment Service Office three copies of the non-resident worker’s contract of employment which shall
include as a minimum: the job title, the duration of the contract, the location of the work, the weekly hours schedule, the wage for regular
and overtime work, any deductions for living costs and statement that the employee’s pay is subject to F.S.M. income tax.
I have attached:
(1) Non-resident worker’s affidavit
Signed:_______________________________________
(2) Employment contract with non-resident worker
(3) Health Services living quarters clearance
Typed Name:___________________________________
Employer
(when applicable)
Date:_______________________________________
Penalties:
Penalties: Any employer who willfully violates any of the provisions of Title 51 of the F.S.M. Code or any of the rules and regulations issued pursuant
Penalties:
Penalties:
thereto; upon conviction thereof, shall be fined not more than two thousand dollars or imprisoned for not more than six months, or both.
SECTION D
SECTION D- - - - STATE ENDORSEMENT
STATE ENDORSEMENT
SECTION D
SECTION D
STATE ENDORSEMENT
STATE ENDORSEMENT
State:_________________________________________
Date Application Received:___________________________
Job Classification:__________________________________
Number of Positions:______________________________
Announcement No.:_________________
Issue Date:______________________
Closing Date:____________________
Qualified Resident Worker: Available:_______________ Unavailable:________________
Agreement No.____________________________
____________________________________________
__________________
State Employment Service Officer
Date
____________________________________________
_______________
FSM Immigration
Date
____________________________________________
_______________
Governor
Date
SECTION E
SECTION E
SECTION E
SECTION E- - - - NATIONAL GO
NATIONAL GO
NATIONAL GO
NATIONAL GOVERNMENT ENDORSEMENT
VERNMENT ENDORSEMENT
VERNMENT ENDORSEMENT
VERNMENT ENDORSEMENT
Job Classification :_________________________________________
Number of Positions :_______________________________________
___________________________________ Date of Approval :_________________________________________
Administrator, Labor
Date of Expiration :________________________________________
TT-RDL-071
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