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Foreign Labor Certification

This form is not to be used for any purpose other than the completion of an application for an employment based visa. It is not necessary to submit the request in duplicate. Please fax the request to the number printed thereon.

This form is to be executed by the employer or counsel for the employer.

  1. This item should contain the name and address of the employer or attorney seeking the information.
  2. Enter your fax number at this item. If this fax number is not in service 24/7 please indicate that fact. Requests with the wrong number will be mailed.
  3. Enter the telephone number of the person requesting the determination.
  4. Indicate the name of the employer.
  5. Enter the employer’s Federal Employer Identification Number.
  6. City and COUNTY of proposed employment
  7. If the employer is a college or university, enter department of proposed employment.
  8. Enter the nature of employer’s business
  9. Title of job for which wage is being sought.
  10. Describe the job to be performed. Use second sheet if necessary. Do not use a type size smaller than 8 point for entries at this item
  11. What are the MINIMUM requirements for the position? (not a listing of the potential worker’ qualifications)
  12. Enter any special requirements that are uniformly required for the position.
  13. Title of the worker’s supervisor.
  14. If the worker will supervise other workers, enter the number of workers supervised.

Make no entries after number 14. That is where the requested information is placed.

It is permissible to photocopy the form.

Failure to provide the requested information will cause the form to be returned for completion.

Should you have any questions, please contact Tim Lawhorn, Labor Certification Specialist at (317)233-6681 or fax your inquiry to (317)233-1884. Email address: tlawhorn@dwd.in.gov