Informational purposes only. Not an Original Certification

Application for Permanent
Employment Certification
ETA Form 9089

U.S. Department of Labor
Employment and Training
Administration

A. Refiling Instructions

Are you seeking to utilize the filing date from a previously submitted Application for Alien Employment Certification ( ETA 750)?

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1-A. If Yes, enter the previous filing date

 

1-B. Indicate the previous SWA or local office case number OR if not available, specify state where case was originally filed:

 

B. Schedule A or Sheepherder Information

Is this application in support of a Schedule A or Sheepherder occupation?

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If Yes, do NOT send this application to the Department of Labor. All applications in support of Schedule A or Sheepherder Occupations must be sent directly to the appropriate Department of Homeland Security Office.

C. Employer Information (Headquarters or main office)

1. Employer's name

UNIVERSITY OF KENTUCKY 

2. Address 1

101 MAIN BUILDING 

Address 2

 

3. City

LEXINGTON 

State/Province

KY 

Country

UNITED STATES OF AMERICA 

Postal Code

40506 

4. Phone Number

859-257-9000 

Extension

 

5. Number of employees

14000 

6. Year commenced business

1865 

7. FEIN (Federal Employer Identification Number)

redacted field

8. NAICS code

6113 

9. Is the employer a closely held corporation, partnership, or sole propri etorship in which the alien has an ownership interest, or is there a familial relationship between the owners, stockholders, partners, corporate officers, incorporators, and the alien?

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D. Employer Contact Information (This section must be filled out. This information must be different from the agent or attorney information listed in Section E)

1. Contact's Last Name

Leibach 

First Name

Elizabeth 

Middle Initial

2. Address 1

University of Kentucky 

Address 2

204 Bradley Hall 

3. City

Lexington 

State/Province

KY 

Country

UNITED STATES OF AMERICA 

Postal Code

40506-0058 

4. Phone Number

859-257-3782 

5. E-mail Address

elizabeth.leibach@uky.edu 

E. Agent or Attorney Information (If applicable)

1. Agent or attorney's Last Name

Rothenbuecher 

First Name

H. Alan 

Middle Initial

 

2. Firm Name

Ice Miller, LLP 

3. Firm EIN

redacted field

4. Phone Number

2163945075 

Extension

 

5. Address 1

600 Superior Avenue East 

Address 2

Suite 1701 

6. City

Cleveland 

State/Province

OH 

Country

UNITED STATES OF AMERICA 

Postal Code

44114 

7. E-mail Address

linda.gemind@icemiller.com 

F. Prevailing Wage Information (as provided by the State Workforce Agency)

1. Prevailing wage tracking number
    (if applicable)

P10011357632730 

2. SOC/O*NET (OES) code

29-1063 

3. Occupation Title

Assistant Professor 

4. Skill Level

Level III 

5. Prevailing Wage

$ 120,570.00 

    Per

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6. Prevailing Wage Source

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6-A. If Other is indicated in question 6,
     specify:

 

7. Determination Date

02/07/2012 

8. Expiration Date

06/30/2012 

G. Wage Offer Information

1. Offered Wage

From $ 235,000.00     To (optional) -

  Per

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H. Job Opportunity Information (Where work will be performed)

1. Primary Worksite (where work is
    to be performed) Address 1

740 S. Limestone Street 

Address 2

L543 KY Clinic 

2. City

Lexington 

State

KY 

Postal Code

40536-0284 

3. Job Title

Assistant Professor 

4. Education: minimum level required

  •     
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  • not checkedHigh School
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  • not checkedBachelor's
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4-A. If Other is indicated in question 4, specify the education required:

M.D. or equivalent foreign degree 

4-B. Major field of study

Medicine 

5. Is training required in the job opportunity?

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5-A. If Yes, number of months of training required:

24 

5-B. Indicate the field of training

Critical Care 

6. Is experience in the job offered required for the job?

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6-A. If Yes, number of months experience required:

 

7. Is there an alternate field of study that is acceptable?

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7-A. If Yes, specify the major field of study:

 

8. Is there an alternate combination of education and experience that is acceptable?

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8-A. If Yes, specify the alternate level of education required:

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8-B. If Other is indicated in question 8-A, Indicate the alternate level of education required:

 

8-C. If applicable, indicate the number of years experience acceptable in question 8:

 

9. Is a foreign educational equivalent acceptable?

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10. Is experience in an alternate occupation acceptable?

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10-A. If Yes, number of months experience in alternate occupation required:

 

10-B. Identify the job title of the acceptable alternate occupation:

 

11. Job Duties - If submitting by mail, add attachment if necessary. Job duties description must begin in this space.

This is a full time faculty position that will participate in teaching efforts (including in the classroom, at noon conference lectures, at the workstation and in the reading rooms) and course development for medical students and residents; participate in research/scholarly activities via studies, clinical research resulting in publications, and other venues; assess and improve professional educational skills, including accumulation of skills and abilities to enhance departmental and college contributions as demonstrated by participation in meetings, seminars and grand rounds; provide clinical services to patients. This position includes night and weekend on call in rotation with other specialists. 

12. Are the job opportunity's requirements normal for the occupation?

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If the answer to this question is No, the employer must be prepared to provide documentation demonstrating that the job requirements are supported by business necessity.
13. Is knowledge of a foreign language required to perform the job duties?

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If the answer to this question is Yes, the employer must be prepared to provide documentation demonstrating that the language requirements are supported by business necessity.
14. Specific skills or other requirements - If submitting by mail, add attachment if necessary. Skills description must begin in this space.

Position requires M.D. or equivalent foreign degree; Board certification in internal medicine; Board certification or eligibility in pulmonary disease and/or critical care medicine; fellowship (24 months) in critical care medicine (as referenced in H.5, 5-A and 5-B); eligibility for valid Kentucky medical license.

15. Does this application involve a job opportunity that includes a combination of occupations?

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16. Is the position identified in this application being offered to the alien identified in Section J?

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17. Does the job require the alien to live on the employer's premises?

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18. Is the application for a live-in household domestic service worker?

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18-A. If Yes, have the employer and the alien executed the required employment contract and has the employer provided a copy of the contract to the alien?

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I. Recruitment Information

a. Occupation type - all must complete this section.

1. Is this application for a professional occupation, other than a college or university teacher? Professional occupation are those for which a bachelor's degree (or equivalent) is nomally required.

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2. Is this application for a college or university teacher?

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If Yes, complete question 2-A and 2-B below.
2-A. Did you select the candidate using a competitive recruitment and selection process?

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2-B. Did you use the basic recruitment process for professional occupations?

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b. Special Recruitment and Documentation Procedures for College and University Teachers - Complete only if the answer to question I.a.2-A is Yes.

3. Date alien selected:

 

4. Name and date of national professional journal in which advertisement was placed:

 

5. Specify additional recruitment information in this space. Add an attachment if necessary.

 

c. Professional/Non-Professional Information - Complete this section unless your answers to questions I.a.1 is No and I.2-B is Yes.

6. Start date for the SWA job order

03/20/2012 

7. End date for the SWA job order

04/19/2012 

8. Is there a Sunday edition of the newspaper in the area of
intended employment?

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9. Name of newspaper (of general circulation) in which the first advertisement was placed:

Lexington Herald Leader 

10. Date of first advertisement identified in question 9:

03/18/2012 

11. Name of newspaper or professional journal (if applicable) in which second advertisement was placed:

Lexington Herald Leader 

       
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12. Date of second newspaper advertisement or date of publication of journal identified in question 11:

03/25/2012 

d. Professional Recruitment Information - Complete if the answer to question I.a.1 is YES or if the answer to I.a.2-B is YES. Complete at least 3 of the items.

13. Dates advertised at job fair

From: - To: -

14. Dates of on-campus recruiting

From: - To: -

15. Dates posted on employer web site

From: 03/16/2012 To: 03/28/2012

16. Dates advertised with trade or professional organization

From: 03/22/2012 To: 03/28/2012

17. Dates listed with job search web site

From: 03/19/2012 To: 04/18/2012

18. Dates listed with private employment firm

From: - To: -

19. Dates advertised with employee referral program

From: - To: -

20. Dates advertised with campus placement office

From: - To: -

21. Dates advertised with local or ethnic newspaper

From: - To: -

22. Dates advertised with radio or TV ads

From: - To: -

e. General Information - All must complete this section.

23. Has the employer received payment of any kind for the submission of this application?

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23-A. If Yes, describe details of the payment including the amount, date and purpose of the payment:

 

24. Has the bargaining representative for workers in the occupation in which the alien will be employed been provided with notice of this filing at least 30 days but not more than 180 days before the date the application is filed?

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25. If there is no bargaining representative, has a notice of this filing been posted for 10 business days in a conspicuous location at the place of employment, ending at least 30 days before but not more than 180 days before the date the application is filed?

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26. Has the employer had a layoff in the area of intended employment in the occupation involved in this application or in a related occupation within the six months immediately preceding the filing of this application?

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  • checkedNo

26-A. If Yes, were the laid off U.S. workers notified and considered for the job opportunity for which certification is sought?

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J. Alien Information (This section must be filled out. This information must be different from the agent or attorney information listed in Section E).

1. Alien's last name

redacted field

First Name

redacted field

Full middle name

redacted field

2. Current address 1

redacted field

Address 2

redacted field

3. City

LEXINGTON 

State/Province

KY  

Country

UNITED STATES OF AMERICA 

Postal Code

40513 

4. Phone number of current residence

redacted field

5. Country of citizenship

INDIA 

6. Country of birth

INDIA 

7. Alien's date of birth

redacted field

8. Class of admission

H-1B 

9. Alien registration number (A#)

redacted field

10. Alien admission number (I-94)

redacted field

11. Education: highest level achieved relevant to the requested occupation:

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11-A. If Other indicated in question 11, specify

M.B.B.S. 

12. Specify major field(s) of study

MEDICINE 

13. Year relevant education completed

1997 

14. Institution where relevant education specified in question 11 was received

JAWAHARLAL INSTITUTE OF POST GRADUATE MEDICAL EDUCATION AND RESEARCH 

15. Address 1 of conferring institution

DHANVANTRI NAGAR, GORIMEDU 

  Address 2

 

16. City

PONDICHERRY 

  State/Province

INDIA (DOES NOT SHOW UP IN COUNTRY FIELD) 

  Country

INDIA 

  Postal Code

605 006 

17. Did the alien complete the training required for the requested job opportunity, as indicated in question H.5?

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  • not checkedNo
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18. Does the alien have the experience as required for the requested job opportunity indicated in question H.6?

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19. Does the alien possess the alternate combination of education and experience as indicated in question H.8?

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20. Does the alien have the experience in an alternate occupation specified in question H.10?

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21. Did the alien gain any of the qualifying experience with the employer in a position substantially comparable to the job opportunity requested?

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22. Did the employer pay for any of the alien's education or training necessary to satisfy any of the employer's job requirements for this position?

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23. Is the alien currently employed by the petitioning employer?

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K. Alien Work Experience
List all jobs the alien has held during the past 3 years. Also list any other experience that qualifies the alien for the job opportunity for which the employer is seeking certification.

1. Employer Name

redacted field

2. Address 1

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     Address 2

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3. City State/Province Country Postal Code

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4. Type of Business

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5. Job Title

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6. Start Date

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7. End Date

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8. Number of hours worked per week

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9. Job Details (duties performed, use of tools, machines, equipment, skills, qualifications, certifications, licenses, etc. Include the phone number of the employer and the name of the alien's supervisor.)

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L. Alien Declaration

I declare under penalty of perjury that Sections J and K are true and correct. I understand that to knowingly furnish false information in the preparation of this form and any supplement thereto or to aid, abet, or counsel another to do so is a federal offense punishable by a fine or imprisonment up to five years or both under 18 U.S.C. §§ 2 and 1001. Other penalties apply as well to fraud or misuse of ETA immigration documents and to perjury with respect to such documents under 18 U.S.C. §§ 1546 and 1621. In addition, I further declare under penalty of perjury that I intend to accept the position offered in Section H of this application if a labor certification is approved and I am granted a visa or an adjustment of status based on this application.
1. Alien's last name

redacted field

First name

redacted field

Full middle name

redacted field

2. Signature Date signed

redacted field

Note - The signature and date signed do not have to be filled out when electronically submitting to the Department of Labor for processing, but must be complete when submitting by mail. If the application is submitted electronically, any resulting certification MUST be signed immediately upon receipt from DOL before it can be submitted to USCIS for final processing.

M. Declaration of Preparer

1. Was the application completed by the employer? If No, you must complete this section.

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I hereby certify that I have prepared this application at the direct request of the employer listed in Section C and that to the best of my knowledge the information contained herein is true and correct. I understand that to knowingly furnish false information in the preparation of this form and any supplement thereto or to aid, abet, or counsel another to do so is a federal offense punishable by a fine, imprisonment up to five years or both under 18 U.S.C. §§ 2 and 1001. Other penalties apply as well to fraud or misuse of ETA immigration documents and to perjury with respect to such documents under 18 U.S.C. §§ 1546 and 1621.
2. Preparer's last name

Rothenbuecher 

First Name

H. Alan 

Middle initial

 

3. Title

Attorney at Law 

4. E-mail address

linda.gemind@icemiller.com 

5. Signature

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  • not checkedNo

Date signed

 

Note - The signature and date signed do not have to be filled out when electronically submitting to the Department of Labor for processing, but must be complete when submitting by mail. If the application is submitted electronically, any resulting certification MUST be signed immediately upon receipt from DOL before it can be submitted to USCIS for final processing.

N. Employer Declaration

By virtue of my signature below, I HEREBY CERTIFY the following conditions of employment: 1. The offered wage equals or exceeds the prevailing wage and I will pay at least the prevailing wage. 2. The wage is not based on commissions, bonuses or other incentives, unless I guarantees a wage paid on a weekly, bi-weekly, or monthly basis that equals or exceeds the prevailing wage. 3. I have enough funds available to pay the wage or salary offered the alien. 4. I will be able to place the alien on the payroll on or before the date of the alien's proposed entrance into the United States. 5. The job opportunity does not involve unlawful discrimination by race, creed, color, national origin, age, sex, religion, handicap, or citizenship. 6. The job opportunity is not: a. Vacant because the former occupant is on strike or is being locked out in the course of a labor dispute involving a work stoppage; or b. At issue in a labor dispute involving a work stoppage. 7. The job opportunity's terms, conditions, and occupational environment are not contrary to Federal, state or local law. 8. The job opportunity has been and is clearly open to any U.S. worker. 9. The U.S. workers who applied for the job opportunity were rejected for lawful job-related reasons. 10. The job opportunity is for full-time, permanent employment for an employer other than the alien. I hereby designate the agent or attorney identified in section E (if any) to represent me for the purpose of labor certification and, by virtue of my signature in Block 3 below, I take full responsibility for the accuracy of any representations made by my agent or attorney. I declare under penalty of perjury that I have read and reviewed this application and that to the best of my knowledge the information contained herein is true and accurate. I understand that to knowingly furnish false information in the preparation of this form and any supplement thereto or to aid, abet, or counsel another to do so is a federal offense punishable by a fine or imprisonment up to five years or both under 18 U.S.C. §§ 2 and 1001. Other penalties apply as well to fraud or misuse of ETA immigration documents and to perjury with respect to such documents under 18 U.S.C. §§ 1546 and 1621.
1. Last name

Moliterno 

First name

David 

Middle initial

2. Title

Chair of Department of Internal Medicine 

3. Signature

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Date signed

 

Note - The signature and date signed do not have to be filled out when electronically submitting to the Department of Labor for processing, but must be complete when submitting by mail. If the application is submitted electronically, any resulting certification MUST be signed immediately upon receipt from DOL before it can be submitted to USCIS for final processing.