DEPARTMENT CERTIFICATION
THE DEPARTMENT / SCHOOL CERTIFIES THE FOLLOWING:
The Department / School and the foreign national are not undertaking this filing solely to obtain permanent
residence for a temporarily employed foreign faculty member. The Department / School and the Faculty
member intend that the faculty member will remain indefinitely employed at the University of South
Alabama.
The Department / School and the foreign national will work closely with OIE to assemble all the required
documentation for a successful conclusion of the PLR process.
The Department / School and the foreign national will pay all fees and a clear, mutual agreement has been
reached between the Department / School and the foreign national as to the payment of USCIS fees.
Supervisor: _________________________________________________________
Chair:
__________________________________________________________
AUTHORIZATION OF THE DEAN
I HEREBY AUTHORIZE AND FULLY SUPPORT THE APPLICATION FOR PERMANENT
RESIDENCE ON BEHALF OF _____________________________________________________
Dean: _________________________________________________________________________
DEPARTMENT CONTACT: _______________________________________________________
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DEPARTMENT QUESTIONNAIRE & RECRUITMENT REPORT
Department Name
Department Contact (name, Phone & email)
Employee name (Last, First, Middle)
Country of Citizenship
Type of Permanent Residence Requested: (Please select
one of the following:)
Labor certification (PERM) processing
Outstanding Researcher/Outstanding Professor
Person of Extraordinary Ability
National Interest Waiver (NIW)
Country of Birth
Job Title
Academic Degree Required for Position (and acceptable
fields like “B.S. in Biology”,”Ph.D. in Engineering”etc.)
Minimum experience required (i.e. 2 years, 5 years, etc.)
Is there an alternate field of study acceptable? If yes,
specify the major field of study.
Is there an alternate combination of education and
experience that is acceptable? If yes, specify the alternate
level of education required. If applicable, indicate the
number of years experience acceptable.
Is a foreign educational equivalent acceptable?
 Yes
 No
Is experience in an alternate occupation acceptable? If yes
indicate number of months experience in alternate
occupation required. Identify the job title of the acceptable
alternate occupation.
Are the job opportunity’s requirements normal for the
occupation? If no, you must be prepared to provide
documentation demonstrating that the job requirements are
supported by university necessity.
Is knowledge of a foreign language required to perform the
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job duties? If so, you must be prepared to provide
documentation demonstrating that the job requirements are
supported by university necessity.
List specific skills or other requirements.
Does the application involve a job opportunity that
includes a combination of occupations?
 Yes
 No
 Yes
 No
If this a teaching position? (University teachers are those
positions which involve some actual classroom teaching.
The teaching a physician does on “teaching rounds” would
not qualify a physician on that basis alone as a university
teacher since the teaching takes place in a clinical rather
than a classroom setting.
 Yes
 No
Was the individual selected using a competitive
recruitment and selection process? If yes, please include
date the individual was selected.
 Yes
 No
Does the job require the individual to live on university
premises?
Brief non-technical description of duties
Work site address & P.O. Box
Annual salary or hourly wage rate
Was the employee provided with a written offer of
employment? If yes what date was the offer letter written?
Is the application for a professional occupation other than a
university teacher? Professional occupations are those
which require a bachelor’s degree (or equivalent) is
normally required.
Name of national professional journal(s) used for
advertisement and date(s) of advertisement(s)
Were other recruitment efforts undertaken?(i.e. employee
referral programs, intranet postings, Department placement
office, job fairs, third party recruiters, state unemployment
office, etc.? State and provide copies of all additional
recruitment efforts and dates undertaken:
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Name of Sunday Edition newspaper used for advertisement
and date of advertisement(s).
Specify the three additional advertisements used (such as
when, what, and where)
Recruitment Report
Please attach.
DEPARTMENT CERTIFICATION
Employee name: _____________________________________________
USA Department: ______________________________________________ certifies that:
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1. The salary being paid to the above name employee is at least the actual wage being paid to all other
individuals with similar experience and qualifications for the specific employment, OR the prevailing wage
level for the occupation in the area of employment, whichever is higher.
2. The fringe benefits offered to this employee are equivalent to that offered to other U.S. workers similarly
employed.
3. Employing this person will not adversely affect the working conditions of U.S. workers similarly employed.
4. There is no strike, lockout, or work stoppage due to labor disputes, in this occupation.
5. Department agrees to post notice of Permanent Residence Filing in conspicuous places in the place of
business (employment office and common business postings ae advised). The posting will remain posted
for at least 10 consecutive business days. After that time period has passed, the posting will be removed,
completed as to the period posted and a copy sent to OIE.
6. Department agrees that Employee is being offered a permanent position, in that an indefinite period of
employment is contemplated and employment will be of greater duration than 1 year.
7. Department fully understands that any willful violation connected with providing inaccurate information
may incur a severe penalty from the Department of Labor or Department of Homeland Security which will
have long range impact on Department business, future recruitment practices and hiring of foreign nationals.
Certified by:
Authorized Department Contact:
Name: _______________________________ Signature: ___________________ Date:_________
Beneficiary Information
The following information requested information on the beneficiary is required to complete the PERM application.
While in most cases OIE will already have much of the requested information in its files through the nonimmigrant
visa application process, it is necessary to have the most up to date information. PLEASE COMPLETE THIS
INFORMATION REQUEST IN FULL.
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Name of Beneficiary (last, first, middle)_________________________________________________________
Date of birth (mmddyyyy): ______________________________________________
Country of birth:___________________________________
Country of citizenship:_____________________________
Current U.S. Address:_____________________________________________________
City:_______________________
State/Province: __________________________
Postal Code:________________________________ Home telephone #: ____________________________
Current Immigration Status: (J-1, H-1B, O-1, etc) ______________________________
If you were ever issued a J visa, were subject to the 2-year home residency requirement:  YES NO
Not
subject. If you were subject to the residency requirement, did you receive a waiver?
 YES
NO
Current I-94 Number: ___________________________
USCIS A# (if any) A_____________________________
SSN: ____________________________
Highest education received:  Associate’s  Bachelor’s  Master’s  PhD  Other (JD, MD, etc.) ________
Specific field of study: _________________________________________
Institution from which degree was earned:___________________________________________________________
Address of Institution: __________________________________________________________________________
City___________________________________ State/ Province: ________________________________________
Country_________________ Postal Code:______________ Date degree awarded: __________________________
Any certifications, licenses, training, residency, computer skills or other qualifications specifically related to or
required for your position here at USA?
Examples of such would include an Alabama State medical license to practice medicine, a CPA designation
for accounting, computer programming language required in your field, etc.
Current position title at USA:_____________________________________________________________________
Date this position began: _____________________________
Current supervisor: ________________________________________________________
Departmental Telephone Number: ____________________________________________
Summary of current job duties:
Education, qualification, certification and licensing requirements for current position:
Prior work experience and other relevant work experience for past 5 years
Please include Graduate Assistantship positions. If you held multiple positions with the same employer, list
separately each position held. (Make duplicate copies of this page as necessary)
Name of employer: ____________________________________________________________________________
Address of employer: __________________________________________________________________________
City: _______________________________________________ State/Province: ___________________________
Country: ___________________________________________ Postal Code: _____________________________
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Employer Telephone Number: _________________________________________________________________
Type of business / institution: __________________________________________________________________
Position title: _________________________________________________________________________________
Number of hours per week: ____________________________________________________________________
Dates in this position: from (mmddyyyy) _______________ To: (mmddyyyy) __________________________
Name of Supervisor: __________________________________________________________________________
Summary of job duties:
Education, qualification, certification and licensing requirements for current position:
Name of employer: ____________________________________________________________________________
Address of employer: __________________________________________________________________________
City: _______________________________________________ State/Province: ___________________________
Country: ___________________________________________ Postal Code: _____________________________
Employer Telephone Number: _________________________________________________________________
Type of business / institution: __________________________________________________________________
Position title: _________________________________________________________________________________
Number of hours per week: ____________________________________________________________________
Dates in this position: from (mmddyyyy) _______________ To: (mmddyyyy) __________________________
Name of Supervisor: __________________________________________________________________________
Summary of job duties:
Education, qualification, certification and licensing requirements for current position:
I certify that the information provided on this form for the PERM and Prevailing Wage Intake Form is
correct.
Print Full Name ____________________________ Signature _________________________ Date __________
EMPLOYEE FAMILY CHECKLIST & QUESTIONNAIRE
Each family member seeking permanent residence must be listed below. Please add additional sheets if necessary.
Please answer all questions completely and clearly to avoid delays. If the answer to a question is NONE or NOT
APPLICABLE, please state “none” or “N/A”. Do not leave any blanks. Type on screen or print clearly.
Spouse’s Full name (last,
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First, Middle):
Country of origin
Country of citizenship
Date of Birth
Child’s Full Name (last,
First, Middle):
Country of birth
Country of citizenship
Date of birth
Employee Signature:___________________________________ Date: ______________________
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