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)?

  • not checkedYes
  • 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?

  • not checkedYes
  • checkedNo

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

RGB SYSTEMS DBA EXTRON ELECTRONICS 

2. Address 1

1025 E. BALL ROAD 

Address 2

 

3. City

ANAHEIM 

State/Province

CA 

Country

UNITED STATES OF AMERICA 

Postal Code

92805 

4. Phone Number

714-687-6232 

Extension

 

5. Number of employees

1400 

6. Year commenced business

1983 

7. FEIN (Federal Employer Identification Number)

redacted field

8. NAICS code

334119 

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?

  • not checkedYes
  • 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

GRUSH 

First Name

JOANNE 

Middle Initial

 

2. Address 1

1025 E. Ball Road 

Address 2

 

3. City

Anaheim 

State/Province

CA 

Country

UNITED STATES OF AMERICA 

Postal Code

92805 

4. Phone Number

714-687-6232 

5. E-mail Address

jgrush@extron.com 

E. Agent or Attorney Information (If applicable)

1. Agent or attorney's Last Name

Spero 

First Name

Kathleen 

Middle Initial

2. Firm Name

Malitzlaw, Inc. 

3. Firm EIN

redacted field

4. Phone Number

6195579129 

Extension

 

5. Address 1

600 W. Broadway 4th Floor 

Address 2

 

6. City

San Diego 

State/Province

CA 

Country

UNITED STATES OF AMERICA 

Postal Code

92101 

7. E-mail Address

katie@malitzlaw.com 

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

1. Prevailing wage tracking number
    (if applicable)

P10015040175128 

2. SOC/O*NET (OES) code

17-2112 

3. Occupation Title

Industrial Engineers 

4. Skill Level

Level I 

5. Prevailing Wage

$ 67,517.00 

    Per

  • not checkedHour
  • not checkedWeekly
  • not checkedBi-weekly
  • not checkedMonth
  • checkedYear

6. Prevailing Wage Source

  • checkedOES
  • not checkedCBA
  • not checkedEmployer Conducted
  • not checkedDBA
  • not checkedSCA
  • not checkedOther

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

 

7. Determination Date

03/26/2015 

8. Expiration Date

06/30/2015 

G. Wage Offer Information

1. Offered Wage

From $ 68,000.40     To (optional) -

  Per

  • not checkedHour
  • not checkedWeekly
  • not checkedBi-weekly
  • not checkedMonth
  • checkedYear

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

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

1025 E. Ball Road 

Address 2

 

2. City

Anehim 

State

CA 

Postal Code

92805 

3. Job Title

Manufacturing Engineer 

4. Education: minimum level required

  •     
  • not checkedNone
  • not checkedHigh School
  • not checkedAssociate's
  • checkedBachelor's
  • not checkedMaster's
  • not checkedDoctorate
  • not checkedOther

4-A. If Other is indicated in question 4, specify the education required:

 

4-B. Major field of study

Industrial Engineering 

5. Is training required in the job opportunity?

  • not checkedYes
  • checkedNo

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?

  • not checkedYes
  • checkedNo

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

 

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

  • not checkedYes
  • checkedNo

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

 

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

  • not checkedYes
  • checkedNo

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

  •      
  • not checkedNone
  • not checkedHigh School
  • not checkedAssociate's
  • not checkedBachelor's
  • not checkedMaster's
  • not checkedDoctorate
  • not checkedOther

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?

  • checkedYes
  • not checkedNo

10. Is experience in an alternate occupation acceptable?

  • checkedYes
  • not checkedNo

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

24 

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

Work experience in electronics assembly, industrial engineering, product packaging, and statistical 

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

Design, development, improvement, and validate manufacturing processes, including performing production line capacity and efficiency work analysis, designing and improving manufacturing processes flows, and developing assembly/manufacturing work instructions and procedures. Develop manufacturing process documentation. Determine requirements for manufacturing and develop manufacturing tool/jig/fixture drawings to aid in manufacturing electronic equipment. Identify and implement improvements to manufacturing process, product cost, cycle time, and quality based on evaluation of process and product performance data. Prepare Engineering reports and support launch of new products from NPI into production. Provide support and training for manufacturing-related activities and manufacturing methods, standards, and activities to Production and other Team Members. 

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

  • checkedYes
  • not checkedNo

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?

  • not checkedYes
  • 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.

Ctd. from H-4: Requires a Bachelor’s degree or equivalent in Industrial Engineering. Ctd. from H-10: Requires 2 years of work experience in electronics assembly, industrial engineering, product packaging, and statistical data reporting and 2 years of work experience in developing statistical analysis tools to identify defects in production or packaging in a manufacturing environment. Ctd. from H-14: Additional skills to include work experience with conducting data collection from test and inspection of products or process to evaluate the quality of performance in the manufacturing environment; work experience with producing professional engineering reports, including root cause, solutions, and recommendations and summary of data to support report research; work experience with analyzing and resolving technical problems from simple to complex issues; work experience utilizing software to develop tools, analyze data, and develop management reports; work experience with using CAD programs for design; work experience translating instructions to production and working with other team members within an organization; and work experience performing minor assembly activities on assembly, sub-assembly, or test systems.

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

  • not checkedYes
  • checkedNo

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

  • checkedYes
  • not checkedNo

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

  • not checkedYes
  • checkedNo

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

  • not checkedYes
  • 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?

  • not checkedYes
  • not checkedNo
  • not checkedN/A

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?

  • not checkedYes
  • 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?

  • not checkedYes
  • not checkedNo

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

  • not checkedYes
  • not checkedNo

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

04/02/2015 

7. End date for the SWA job order

05/02/2015 

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

  • checkedYes
  • not checkedNo

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

Orange County Register 

10. Date of first advertisement identified in question 9:

04/05/2015 

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

Orange County Register 

       
  • checkedNewspaper
  • not checkedJournal

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

04/12/2015 

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: 04/17/2015 To: 04/24/2015

16. Dates advertised with trade or professional organization

From: - To: -

17. Dates listed with job search web site

From: 04/02/2015 To: 04/15/2015

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: 04/17/2015 To: 04/20/2015

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?

  • not checkedYes
  • 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?

  • not checkedYes
  • not checkedNo
  • checkedN/A

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?

  • checkedYes
  • not checkedNo
  • not checkedN/A

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?

  • not checkedYes
  • checkedNo

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

  • not checkedYes
  • not checkedNo
  • not checkedN/A

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

IRVINE 

State/Province

CA  

Country

UNITED STATES OF AMERICA 

Postal Code

92612 

4. Phone number of current residence

redacted field

5. Country of citizenship

IRAN 

6. Country of birth

IRAN 

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:

  •     
  • not checkedNone
  • not checkedHigh School
  • not checkedAssociate's
  • 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

INDUSTRIAL ENGINEERING 

13. Year relevant education completed

2013 

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

ARIZONA STATE UNIVERSITY 

15. Address 1 of conferring institution

1151 SOUTH FOREST AVENUE, 

  Address 2

 

16. City

TEMPE 

  State/Province

AZ  

  Country

UNITED STATES OF AMERICA 

  Postal Code

85281 

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

  • not checkedYes
  • not checkedNo
  • checkedN/A

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

  • not checkedYes
  • not checkedNo
  • checkedN/A

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

  • not checkedYes
  • not checkedNo
  • checkedN/A

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

  • checkedYes
  • not checkedNo
  • not checkedN/A

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

  • not checkedYes
  • checkedNo
  • not checkedN/A

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?

  • not checkedYes
  • checkedNo

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

  • checkedYes
  • not checkedNo

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

redacted field

3. City State/Province Country Postal Code

redacted field

4. Type of Business

redacted field

5. Job Title

redacted field

6. Start Date

redacted field

7. End Date

redacted field

8. Number of hours worked per week

redacted field

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.)

redacted field

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.

  • not checkedYes
  • 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

Spero 

First Name

Kathleen 

Middle initial

3. Title

Attorney 

4. E-mail address

katie@malitzlaw.com 

5. Signature

  • not checkedYes
  • 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

Grush 

First name

Joanne 

Middle initial

2. Title

Vice President, Human Resources 

3. Signature

  • not checkedYes
  • 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.