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Prevailing Wage Request Form NCSES FLC-PW-4 - North Carolina

Prevailing Wage Request Form Form. This is a North Carolina form and can be used in Administrative Statewide .
 Fillable pdf Last Modified 4/9/2009
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Please return to: Applicant Services Unit P.O. Box 27625 Raleigh, NC 27611 Phone: 919-733-4896 Fax: 919-733-3010 EMPLOYMENT SECURITY COMMISSION OF NORTH CAROLINA RALEIGH, NORTH CAROLINA 27611 PREVAILING WAGE REQUEST FORM Please check one: ___ H-1B Professional ___ Perm (incl. nurses) ___ H-2B Allow up to 14 business days for processing H-1B/Perm and up to 30 days for H-2B. A. To be completed by Employer or Employer Representative 1. Name of Employer (Full name of organization): 2. Physical Address of Job Site: (Include street, city, state and zip code) 3. Telephone (Include Area Code): 6. Suggested OES/SOC Code: (If Known) 4. Nature of Employer's Business: 7. Is This a Renewal? Yes No If yes, attach previous determination. 5. Job Title: 8. Total Hrs. Per Week: 9. Rate of Pay: $___________________per _____________ 10. Describe fully the job to be performed (Duties): The duties must begin in this section. If additional space is needed, attachments may be used. 11. Special Requirements: (Do not include alternate education and experience requirements) 12: State in detail the minimum education, training, and experience; not the foreign national's qualifications: Education (no. of years) Experience Training Grade School Yrs. Yrs. High School Mos. Mos. Type of Training Required: College College degree (specify field of study): 13: Supervise Others? Yes Number Supervised: Requestor's Name and Address: No Tel. No: _______________________________ Fax No: _______________________________ B. FOR ESC USE ONLY Case Number: ______________________________________________ DOT/SOC Code: _____________________________________ O*NET/SOC Code: _____________________________________ O*NET/SOC Title: ________________________________________________________________________________________________________ Wage Determination: ________________________per_________________ Level 1 _______________ Level 2 _______________ Level 3 _______________ Level 4 _______________ _____Alternate Survey _____Collective Bargaining Agreement: ______________________per_________________ ____________________________________________Validity Period_______________________________________________________________________ OES Wage Determinations issued on or after July 1, 2008 are valid through June 30, 2009. OES Wage Determinations issued in April, May, or June of 2009 are valid for 90 days beginning with the date of issuance. OES Wage Determinations issued on or after July 1, 2009 are valid through June 30, 2010. Employers must file their applications, or begin their recruitment within the validity period. The employer is not required to submit this form with the application/attestation, but is required to retain this document for five (5) years from the date of filing. Published surveys valid for at least 90 days, or until next publication, but not to exceed one year. SCA/DBA/Employer-conducted surveys valid for 90 days. Collective Bargaining Agreements valid for at least 90 days or until next renewal, but not to exceed one year from date of issuance. ESC Representative ______________________________________________________________ NCSES FLC-PW-4 (revised Jan 09) American LegalNet, Inc. www.FormsWorkflow.com Date _________________________________________
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