H-2B Application for Temporary Employment Certification

• Legal Form Number: 9142B
• Issuer: Employment and Training Administration
• Section: U.S. Department of Labor

1.Is the employer seeking to employ any H-2B workers under this application who will be exempt

from the statutory numerical limit, or “cap,” on the total number of foreign nationals who may

be issued an H-2B visa or otherwise granted H-2B status? *

OMB Approval: 1205-0509

Expiration Date: 05/31/2022

H-2B Application for Temporary Employment Certification

Form ETA-9142B

U.S. Department of Labor

IMPORTANT: Employers and authorized preparers must read the general instructions carefully before completing the Form ETA-9142B. A copy of the instructions

can be found at http://www.foreignlaborcert.doleta.gov/. If you are not submitting this electronically, please complete ALL required fields/items containing an asterisk

(*) and any fields/items where a response is conditional as indicated by the section (§) symbol.

A.Nature of H-2B Application

Yes No

B.Temporary Need Information

1.Job Title *

2.SOC Code *

3.SOC Occupation Title *

4.Number of

Workers *

5.Begin Date *

(mm/dd/yyyy)

6.End Date *

(mm/dd/yyyy)

7.Nature of Temporary Need

(Choose only one)

*

SeasonalPeakloadOne-Time OccurrenceIntermittent

8.Statement of Temporary Need *

(Must be disclosed on this form. One separate attachment will be accepted to fully complete the response.)

C.Employer Information

1.Legal Business Name *

2.Trade Name/Doing Business As (DBA), if applicable

§

3.Address 1 *

4.Address 2

(apartment/suite/floor and number)

§

5.City *

6.State *

7.Postal Code *

8.Country *

9.Province §

10.Telephone Number *

11.Extension §

12.Federal Employer Identification Number

(FEIN from IRS)

*

13.NAICS Code *

Form ETA-9142B FOR DEPARTMENT OF LABOR USE ONLY Page 1 of 5

H-2B Case Number: __________________ Case Status: __________________ Determination Date: _____________ Validity Period: _____________ to _____________