DOL OFLC, Form ETA-9142C, Appendix B - Additional Worksite and Wage Information

OMB Approval: 1205-0534 Expiration Date: 04/30/2026 CW-1 Application for Temporary Employment Certification Form ETA-9142C - Appendix B U.S. Department of Labor 1. City * 2. Postal/ZIP Code * 3. Additional Place of Employment Information § (Address—e.g., street address, area, town, village, geographic identification) 4.

Additional Work Itinerary Information § Crew ID Total Workers Begin Date End Date From: To: Per Basic Wage Rate (in $) For the public burden statement, please see the Form ETA-9142C, General Instructions. Form ETA-9142C -Appendix B FOR DEPARTMENT OF LABOR USE ONLY Page B.1 of B.1 CW-1 Case Number: ____________________ Case Status: _______________________ Determination Date: _____________ Validity Period: _____________ to _____________