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H-1B Nonimmigrant Information Form WH-4 - Official Federal Forms
| H-1B Nonimmigrant Information Form Form. This is a national form and can be used in US Dept Of Labor . |
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H-1B Nonimmigrant U.S. Department of Labor ESA Form WH-4 Information Form Employment Standards mAdinistration OMB Approval: 1205-0310 Expiration Date: 08/31/2007 This report is zauthoried by G8 U.S.C. 1182(n)(2)()(ii) of mthe Aerican Competitiveness and Workforce Improvement Act (ACWIA) of . 1998 The information provided on this form will assist the Department of mLabor in deteri ning whether the named employer of mmH-1B nonii grants has committed a violation of rpovisions of -the H1B program. Your identity fwill be kept conidential to the fu llest extent provided by law. sPleae provide as much of sthe requeted info rmation as sspoi ble. cAttah additional sheets if you need additional space to respond to a question. If you do not understand a term, or need assi stance in the co mpletion of this form, please contact the local Wage and Hour office of the U.S. Department of Labor. fAter you submit the fo rm, a representative from mthe Departent of mLabor ay contact you if further information is cneessa ry vto initiate an inestigation. 1. Person Submitting Information (please print) Mr., Miss, Mrs., Ms. First Name Mi ddle Initial Last Name Current Address: Number, Street, Apt, or P.O. Box No. City, State, ZIP Code Telephone Number: (including area code) Days /Times When You Can be Reached at that Number: E-Mail Address (optional): 2. Nature of Sources Relationship to Employer; (Please check all that apply) (a) H-1B Nonimmigrant Employee Former or Current Employee (dates yof emploment): (b) U.S. Wokr er Former or Current Employee (dates yof emploment): (c) Job Applicant (date of application): (d) Competitor Busi ness (please speciyf ): (e) Federal Government Agency (please specify): (f) State or Local Go vernment Agency (please speciyf ): (g) Community vor Serice Organiza tion (please speciyf ): (h) Other (please speciyf ): - 1 <<<<<<<<<********>>>>>>>>>>>>> 23. Information on H-1B Employer ACommitting lleged Violation Name of mE ployer/Company: Address: Number, Street iC ty State ZIP Code Employer Representative to be Contacted: Telephone Number (including area code): 4. Description of Alleged H-1B Violations Please chec k the appropriate box(es), (a) through (q), which best describe the violation of the H-1B provisions of the Immigration and Nationality Act which you believe have occurred. In secion 8, t identify each item checked and describe, in as much detail as possible, the facts and circumsanct es which cause you to believe that violations have occurred. (a) Employer supplied incorrect or false information on the Labor Certification Application (LCA). (b) Employer failed to pay kH-1B worer(s) the higher of vthe preailing or actual wage. (c) Employer failed to pay kH-1B worer(s) fo r time off due to a decision by mthe eployer (e.g., for lack of kwor) or for time needed by kthe H-1B worer(s) to acquire a license or permi t. (d) Employer made illegal deductions from -H1B workers wages (e.g., for H-1B petition processi ng; for food and housing expens es kwhile the worer Is vtra eling on employers bus iness; for tools and equipment neces sa ry to perform employers work). (e) Employer failed to provide fringe benefits kto H-1B worer(s) equiva lent to those provided to U.S. worker(s) (e.g., cash bonuses, s tock options, paid vaca tions and holidays health benef, its , insurance, retirement and savings plans). (f) Employer does ffnot ao rd H-1B worker(s) working conditions s(hour, shifts, vacation periods) on the same basis as it does U.S. worker(s), or the employ ment of H-1B worker(s) adversely affects the working conditions of U.S. worker(s). (g) Employer failed to comply swith "no trike/lockout" requirement by: 1) placing or contracting out H-1B worker(s) during the validity period of the LCA to any place of employment where there is a labor dispute; 2) failing to notify the DOL, within 3 working days of the occurrence, of such a labor dispute; or 3) using an LCA for H-1B worker(s) to work at a site before the DOL has determined that a labor dispute has ended. (h) Employer failed to provide employees cor their o llective bargaining representative, either by hard copy posting or electronically, notice of its intentions to hire H-1B worker(s), or has failed to provide H-1B worker(s) with a copy of the LCA. (i) Employer required H-1B worker(s) to pay all or any rpat of f$500/$1000 iling fee. (j) Employer imposed an illegal penalty kon H-1B worer(s) fo r ceasing employment with the employer prior to a date agreed upon by kthe worer and employer. (k) Employer retaliated or discriminated against an employee, former employee, or j ob applicant for disclosing information, fling a complaint, or cooperating in an invesigation or procteeding about a violation of the H-1B laws and regulations (i.e., whistleblower). - 2 <<<<<<<<<********>>>>>>>>>>>>> 3(l) Employer failed to maintain and make available for public xeamination the LCA and necessa ry cdouments mat the eployers cprini pal place of sbuiness or worksite. (m) Employer laid off U.S. worker(s) and has creplaed or seeks to replace U.S. worker(s) with H 1B worker(s) within 90 days before or after filing H-1B visa petitions. (n) Employer placed H-1B worker(s) at another employers kswori te where U.S. workers vhae been laid off and/or has, failed to inquire of the second employer whether it has or intends to lay-off U.S. worker(s) and replace them with H-1B worker(s). (o) Employer failed to recruit U.S. worker(s) for jobs for which H-1B worker(s) are sought. (p) Employer failed to hire a U.S. worker who applied and was equally for better qualiied fo r the job for which the H-1B worker was sought. Complaints regarding this violation should be filed with the th U.S. Department of Just ice, 10 and Constitution Ave., N.W., Wa shington, D.C., 20530. (q) Other 5. Date(s) of sAlleged Violation(): 6. Location of Worksite(s) where Alleged Violation(s) occurred: 7. Basis of Knowledge of sAlleged Violation(): 8. Description of facts and circumstances cwhih support allegations min ites 4 (a) through (q). sUe additional sheets of paper, if neces sa ry. FOR DOL USE ONLY Complaint Received/Taken by: Date: Source of mCoplain t is: Aggrieved Party Credible information source Public Burden Statement : W esetimat ite will tak an aveerage of 20 m inutes to comletpe tish frmo, including the time for reviewing instructions, searching existng datia sourc es, gathering and maintaining the data needed, and comletping and reviewing the collection of informatio
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