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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  • checkedNo

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

CALIFORNIA DEPARTMENT OF PESTICIDE REGULATION 

2. Address 1

1001 I STREET 

Address 2

 

3. City

SACRAMENTO 

State/Province

CA 

Country

UNITED STATES OF AMERICA 

Postal Code

95814 

4. Phone Number

(916) 445-4163 

Extension

 

5. Number of employees

410 

6. Year commenced business

1991 

7. FEIN (Federal Employer Identification Number)

redacted field

8. NAICS code

926140 

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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  • checkedNo

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

FARNSWORTH 

First Name

GEORGE 

Middle Initial

 

2. Address 1

1001 I STREET 

Address 2

 

3. City

SACRAMENTO 

State/Province

CA 

Country

UNITED STATES OF AMERICA 

Postal Code

95812 

4. Phone Number

(916) 445-4163 

5. E-mail Address

GFARNSWORTH@CDPR.CA.GOV 

E. Agent or Attorney Information (If applicable)

1. Agent or attorney's Last Name

KANTER 

First Name

ANN 

Middle Initial

 

2. Firm Name

KANTER IMMIGRATION LAW OFFICE 

3. Firm EIN

redacted field

4. Phone Number

(916) 443-6918 

Extension

 

5. Address 1

517A 19TH STREET 

Address 2

 

6. City

SACRAMENTO 

State/Province

CA 

Country

UNITED STATES OF AMERICA 

Postal Code

95811 

7. E-mail Address

AKANTER@KANTERLAW.COM 

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

1. Prevailing wage tracking number
    (if applicable)

P10011313289553 

2. SOC/O*NET (OES) code

19-1041 

3. Occupation Title

EPIDEMIOLOGIST 

4. Skill Level

 

5. Prevailing Wage

$ 5,796.00 

    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

01/09/2012 

8. Expiration Date

06/30/2012 

G. Wage Offer Information

1. Offered Wage

From $ 5,796.00     To $ 7,044.00

  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

1001 I STREET 

Address 2

 

2. City

SACRAMENTO 

State

CA 

Postal Code

95814 

3. Job Title

RESEARCH SCIENTIST III (EPIDEMIOLOGIST/BIOSTATISTICIAN) 

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:

 

4-B. Major field of study

EPIDEMIOLOGY 

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:

12 

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:

BIOLOGICAL SCIENCES, PREVENTIVE VETERINARY MEDICINE, TOXICOLOGY, OR CLOSELY RELATED 

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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  • not checkedBachelor's
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  • checkedDoctorate
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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:

12 

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

EPIDEMIOLOGIST 

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

SEE ATTACHMENT. UNDER THE SUPERVISION OF THE ENVIRONMENTAL PROGRAM MANAGER, PLANS AND CARRIES OUT COMPREHENSIVE SCIENTIFIC RESEARCH STUDIES RELATED TO PESTICIDE ILLNESS SURVEILLANCE AND EPIDEMIOLOGY. CONDUCTS STUDIES OF PESTICIDE ILLNESS TRENDS AND DETAILED ANALYSIS OF COMPLEX ILLNESS EPISODE INVESTIGATIONS AND MAKES PUBLIC HEALTH RECOMMENDATIONS BASED ON FINDINGS. PREPARES REPORTS AND WRITES SCIENTIFIC PAPERS ON RESEARCH STUDIES, ILLNESS DATA TRENDS AND COMPLEX EPISODE INVESTIGATIONS. PRESENTS SCIENTIFIC RESEARCH RESULTS TO EXPERTS, REGULATED COMMUNITY, OTHER GOVERNMENT AGENCIES AND THE PUBLIC. SERVES AS A DEPARTMENT REPRESENTATIVE ON PUBLIC HEALTH PROJECTS AND COMPLEX EPISODE INVESTIGATIONS AND ACTS AS A TECHNICAL SCIENTIFIC CONSULTANT. RESPONDS TO PUBLIC INQUIRIES CONCERNING SPECIFIC QUESTIONS ABOUT THE PESTICIDE ILLNESS SURVEILLANCE PROGRAM DATA. WRITES REPORTS, DOCUMENTS, TECHNICAL PUBLICATIONS AND PEER-REVIEWED JOURNAL PUBLICATIONS ON BIOSTATISTICS AS IT RELATES TO THE HUMAN EXPOSURE AND PUBLIC HEALTH WITH RESPECT TO IMPACT AND MITIGATION OF PESTICIDE EXPOSURES. MAINTAINS FAMILIARITY WITH EPIDEMIOLOGIC METHODS APPROPRIATE TO PESTICIDE ILLNESS SURVEILLANCE AND PUBLIC HEALTH. INVESTIGATES METHODS AND TECHNOLOGIES THAT HAVE THE POTENTIAL TO PREVENT ADVERSE PUBLIC AND ENVIRONMENTAL HEALTH EFFECTS FROM PESTICIDE EXPOSURE. CREATES COMPUTER APPLICATIONS AND STATISTICAL MODELS USING STATISTICAL SOFTWARE (SUCH AS SAS) AND PROGRAMMING TOOLS (SUCH AS VISUAL BASIC). USING STATISTICAL TOOLS AND APPROPRIATE SOFTWARE PACKAGES, IDENTIFIES APPROPRIATE STATISTICAL ESTIMATES OF HUMAN EXPOSURE DISTRIBUTION AND PROVIDES MEASURES OF THE UNCERTAINTY IN THESE ESTIMATES. SERVES AS PUBLIC HEALTH ADVISOR TO DEPARTMENT SCIENTISTS TO PROVIDE AUTHORITATIVE INDEPENDENT SCIENTIFIC CONSULTATION ARE OF BIOSTATISTICS AS IT RELATES TO PUBLIC SAFETY OF PESTICIDES, RESEARCH STUDY METHODOLOGIES, STUDY DESIGN AND DATA ANALYSIS. INDEPENDENTLY REVIEWS PROPOSED PROJECTS SUBMITTED BY DEPARTMENT AND OTHER AGENCIES FOR STATISTICAL INTEGRITY AND APPLICATION TO PROGRAM OBJECTIVES. REVIEWS SCIENTIFIC REPORTS AND PROVIDES CONSTRUCTIVE CRITICISM. EVALUATES, ADVISES AND CONSULTS ON EPIDEMIOLOGIC STUDIES SUBMITTED BY OTHER ORGANIZATIONS AND RESEARCHERS. REVIEWS SIGNIFICANT LEGISLATION AND PROVIDES ANALYSIS AND RECOMMENDATIONS FOR AMENDMENTS. 

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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  • checkedNo

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.

SEE ATTACHMENT. EDUCATION: M.S. DEGREE OR PH.D. IN EPIDEMIOLOGY, BIOLOGICAL SCIENCES, PREVENTIVE VETERINARY MEDICINE, TOXICOLOGY OR CLOSELY RELATED FIELD EXPERIENCE: WITH M.S. DEGREE - ONE YEAR IN CALIFORNIA STATE SERVICE PERFORMING SCIENTIFIC RESEARCH DUTIES IN THE OCCUPATION OF EPIDEMIOLOGIST OR CLOSELY RELATED FIELD OR WITH PH.D. - ONE YEAR EXPERIENCE IN THE OCCUPATION OF EPIDEMIOLOGIST WITH MAJOR RESPONSIBILITY FOR COMPLEX RESEARCH PROJECT OR COORDINATION OF A COMPLEX RESEARCH EFFORT SPECIAL REQUIREMENTS QUALIFYING EXPERIENCE MUST INCLUDE DEMONSTRATED COMPETENCY IN THE FOLLOWING: 1. BIOSTATISTICS 2. INVESTIGATIVE SKILLS AS IT APPLIES TO ILLNESS INVESTIGATIONS 3. PROJECT PLANNING AND IMPLEMENTATION 4. DATABASE DESIGN AND MANAGEMENT 5. DESIGN AND EXECUTION OF COMPLEX, HIGHLY SPECIALIZED RESEARCH PROJECT IN PESTICIDE ILLNESS EPIDEMIOLOGY

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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  • checkedNo

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

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  • checkedNo

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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  • not checkedNo
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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.

  • checkedYes
  • not checkedNo

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

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  • checkedNo

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

01/19/2012 

7. End date for the SWA job order

02/20/2012 

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:

SACRAMENTO BEE 

10. Date of first advertisement identified in question 9:

01/15/2012 

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

SACRAMENTO BEE 

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

01/22/2012 

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: - To: -

16. Dates advertised with trade or professional organization

From: - To: -

17. Dates listed with job search web site

From: 01/15/2012 To: 01/30/2012

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: 01/18/2012 To: 02/17/2012

21. Dates advertised with local or ethnic newspaper

From: 01/17/2012 To: 01/17/2012

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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  • checkedNo

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?

  • checkedYes
  • not checkedNo
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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

WEST SACRAMENTP 

State/Province

CA  

Country

UNITED STATES OF AMERICA 

Postal Code

95691 

4. Phone number of current residence

redacted field

5. Country of citizenship

PHILIPPINES 

6. Country of birth

PHILIPPINES 

7. Alien's date of birth

redacted field

8. Class of admission

F-1 

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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  • not checkedBachelor's
  • checkedMaster's
  • not checkedDoctorate
  • not checkedOther

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

 

12. Specify major field(s) of study

BIOLOGICAL SCIENCES 

13. Year relevant education completed

2005 

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

CALIFORNIA STATE UNIVERSITY, SACRAMENTO 

15. Address 1 of conferring institution

6000 J STREET 

  Address 2

 

16. City

SACRAMENTO 

  State/Province

CA  

  Country

UNITED STATES OF AMERICA 

  Postal Code

95819 

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
  • checkedN/A

18. Does the alien have the experience as required for the requested job opportunity indicated in question H.6?

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  • not checkedNo
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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?

  • checkedYes
  • not checkedNo
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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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  • checkedNo
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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

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     Address 2

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3. City State/Province Country Postal Code

redacted field

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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  • checkedNo

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

KANTER 

First Name

ANN 

Middle initial

3. Title

ATTORNEY AT LAW 

4. E-mail address

AKANTER@KANTERLAW.COM 

5. Signature

  • checkedYes
  • not checkedNo

Date signed

06/28/2012 

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

FARNSWORTH 

First name

GEORGE 

Middle initial

 

2. Title

ENVIRONMENTAL PROGRAM MANAGER I 

3. Signature

  • checkedYes
  • not checkedNo

Date signed

06/20/2012 

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.