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

BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC. 

2. Address 1

4800 DEERWOOD CAMPUS PARKWAY 

Address 2

BUILDING 100-7 

3. City

JACKSONVILLE 

State/Province

FL 

Country

UNITED STATES OF AMERICA 

Postal Code

32246 

4. Phone Number

904 905-6768 

Extension

 

5. Number of employees

11500 

6. Year commenced business

1980 

7. FEIN (Federal Employer Identification Number)

redacted field

8. NAICS code

524114 

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

Williams 

First Name

Carol 

Middle Initial

 

2. Address 1

4800 Deerwood Campus Parkway 

Address 2

Building 100-7 

3. City

Jacksonville 

State/Province

FL 

Country

UNITED STATES OF AMERICA 

Postal Code

32246 

4. Phone Number

904 905-6768 

5. E-mail Address

carol.williams@bcbsfl.com 

E. Agent or Attorney Information (If applicable)

1. Agent or attorney's Last Name

DEARING 

First Name

MELISSA 

Middle Initial

2. Firm Name

SMITH, GAMBRELL & RUSSELL, LLP 

3. Firm EIN

redacted field

4. Phone Number

(904) 598-6131 

Extension

 

5. Address 1

50 NORTH LAURA STREET 

Address 2

SUITE 2600 

6. City

JACKSONVILLE 

State/Province

FL 

Country

UNITED STATES OF AMERICA 

Postal Code

32202 

7. E-mail Address

MDEARING@SGRLAW.COM 

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

1. Prevailing wage tracking number
    (if applicable)

P10014220316023 

2. SOC/O*NET (OES) code

15-1132 

3. Occupation Title

SOFTWARE DEVELOPERS, APPLICATIONS 

4. Skill Level

Level IV 

5. Prevailing Wage

$ 97,864.00 

    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

09/15/2014 

8. Expiration Date

06/30/2015 

G. Wage Offer Information

1. Offered Wage

From $ 98,467.50     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

4800 DEERWOOD CAMPUS PARKWAY 

Address 2

 

2. City

JACKSONVILLE 

State

FL 

Postal Code

32246 

3. Job Title

DEVELOPER III/SENIOR DEVELOPER 

4. Education: minimum level required

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

 

4-B. Major field of study

COMPUTER SCIENCE, ENGINEERING OR MATHEMATICS 

5. Is training required in the job opportunity?

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

 

5-B. Indicate the field of training

 

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

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

60 

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.

JOB DUTIES INCLUDE PERFORMING DETAIL DESIGN DOCUMENTATION, DEVELOPMENT, EVALUATION AND PERFORMANCE TESTING, UNIT TESTING AND MAINTENANCE OF INTERNALLY DEVELOPED AND EXTERNALLY PURCHASED SOFTWARE APPLICATIONS; DEVELOPING BUSINESS RELATIONSHIPS AND INTEGRATING ACTIVITIES WITH OTHER IT DEPARTMENTS, I.E., SECURITY, DATABASE ADMINISTRATORS, ETC., TO ENSURE SUCCESSFUL IMPLEMENTATION AND SUPPORT OF PROJECT EFFORTS; PROVIDING SUBJECT MATTER EXPERTISE (SME) INPUT TO FELLOW IT STAFF ON “WORKABILITY” OF DESIGNS, ARCHITECTURE, AND TESTING; RESEARCHING AND RECOMMENDING SOLUTIONS TO CLIENT REQUIREMENTS, AS NEEDED; WRITING IBM WEBSPHERE PORTAL AND IBM WEB CONTENT MANAGER (WCM) CODE FOR DESIGNS THAT SPAN PLATFORMS; CODING TO AND CREATING APPLICATION PROGRAMMING INTERFACES (APIS); PROVIDING SCOPE, SIZING AND ESTIMATES REQUIRED TO COMPLETE CODE AND PROVIDING THIS INFORMATION TO THE PROJECT MANAGER FOR INPUT TO THE PROJECT PLAN; DETERMINING IMPACTS AND INTEGRATION POINTS; PARTICIPATING IN CAPACITY PLANNING WITH PROJECT MANAGER OR FUNCTIONAL MANAGER; TRANSLATING SPECIFICATION DOCUMENT REQUIREMENTS INTO CODE; CREATING OR MODIFYING CODE FOR COMPLEX DESIGNS THAT SPAN PLATFORMS; ENSURING CODE COMPLIES WITH BCBSF ARCHITECTURAL AND SOFTWARE DEVELOPMENT LIFE CYCLE (SDLC) STANDARDS; WRITING SCRIPTS TO RUN PROGRAMS AND WRITING DETAILED TECHNICAL SPECIFICATIONS; IDENTIFYING INTEGRATION POINTS; REVIEWING TECHNICAL SPECIFICATIONS CREATED BY JUNIOR DEVELOPERS; ENSURING SUFFICIENT QUALITY AND COMPLIANCE OF DOCUMENTATION TO ARCHITECTURAL STANDARDS; INTERFACING WITH EXTERNAL VENDORS AND CUSTOMERS THROUGH CROSSWALK MAPPING WITH DIFFERENT AND OFTEN COMPLEX ARCHITECTURE; PERFORMING UNIT TESTING AND PREPARING APPLICATION FOR RELEASE TO TESTING TEAM; ANALYZING DEFECTS FOUND IN TESTING AND FIXING CODING ERRORS; COORDINATING ACTIVITIES WITH OTHERS ON ALL PHASES OF SDLC; ASSISTING WITH PRODUCTION SUPPORT ISSUES/PROBLEMS AS REQUIRED; RESPONDING TO AND RESOLVING PRODUCTION SUPPORT ISSUES; AND LEADING TEAM EFFORTS IN DEVELOPING SOLUTIONS TO DIFFICULT OR COMPLEX CLIENT SITUATIONS TO ENSURE GOALS AND OBJECTIVES ARE MET. 

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.

Any suitable combination of education, training or experience is acceptable, including a foreign degree evaluated as the equivalent of a U.S. degree. Job requirements include a Bachelor’s Degree in Computer Science, Engineering or Mathematics and 5 or more years of progressive work experience or a Master’s Degree in Computer Science, Engineering or Mathematics and 3 or more years of work experience in a programming or application development role; 3 or more years of work experience writing IBM Websphere PORTAL code and WCM code for applications such as insurance, online sales, provider directories, claims processing, employee tools or member self service tools; 1 or more years of experience in a technical lead role; experience with Linux OR AIX; experience developing interfaces with XML and web based services; demonstrated experience using debugging tools RAD; demonstrated experience using versioning tools clear case or subversion; demonstrated experience with Software Development Life Cycle; experience developing multi-threaded applications and API’s; and experience with unit testing, debugging, optimization, release management, J2EE, RAD, Apache Struts, Unix Shell Scripting, Db2, SQL, HTML, and XML.

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

07/23/2014 

7. End date for the SWA job order

08/22/2014 

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:

THE FLORIDA TIMES UNION 

10. Date of first advertisement identified in question 9:

08/03/2014 

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

THE FLORIDA TIMES UNION 

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

08/10/2014 

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: 07/23/2014 To: 08/22/2014

16. Dates advertised with trade or professional organization

From: - To: -

17. Dates listed with job search web site

From: - To: -

18. Dates listed with private employment firm

From: - To: -

19. Dates advertised with employee referral program

From: 07/23/2014 To: 08/22/2014

20. Dates advertised with campus placement office

From: 08/12/2014 To: 08/22/2014

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

JACKSONVILLE 

State/Province

FL  

Country

UNITED STATES OF AMERICA 

Postal Code

32224 

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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  • checkedBachelor's
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  • not checkedDoctorate
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11-A. If Other indicated in question 11, specify

 

12. Specify major field(s) of study

COMPUTER SCIENCE 

13. Year relevant education completed

2005 

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

DEPARTMENT OF ELECTRONICS ACCREDITATION OF COMPUTER COURSES (DOEACC) 

15. Address 1 of conferring institution

ELECTRONICS NIKETAN 

  Address 2

6 CGO COMPLEX 

16. City

NEW DELHI 

  State/Province

DELHI 

  Country

INDIA 

  Postal Code

110003 

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

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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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  • checkedNo
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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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  • checkedNo

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

redacted field

     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

DEARING 

First Name

MELISSA 

Middle initial

3. Title

ATTORNEY 

4. E-mail address

MDEARING@SGRLAW.COM 

5. 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.

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

HORNE 

First name

SUZANNE 

Middle initial

2. Title

VICE PRESIDENT AND SENIOR COUNSEL 

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.