University of South Alabama Office of International Education
Alpha Hall South, Room 338 Mobile, AL 36688
Ph: 251-460-7104/ Email: visa@southalabama.edu
PERMANENT LABOR APPLICATION INTAKE FORM
NAME OF DEPARTMENT / SCHOOL: USA or USA HCM LLC (Please circle one)
_____________________________________________________________________________________
NAME OF FOEIGN EMPLOYEE:
_____________________________________________________________________________________
TYPE OF PERMANENT RESIDENCE REQUESTED: __________________________________________
LABOR CERTIFICATION (PERM) PROCESSING
OUTSTANDING RESEARCHER / OUTSTANDING PROFESSOR
PERSON OF EXTRAORDINARY ABILITY
NATIONAL INTEREST WAIVER (NIW)
 SPECIAL HANDLING
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 or staff member.
-
(If faculty member) The Department / School and the Faculty member intend that the faculty
member will pursue a tenure-track position 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 and the foreign national will pay all fees as to the payment of USCIS fees and
attorney fees when applicable.
Supervisor: _________________________________________________________
Chair:
__________________________________________________________
AUTHORIZATION OF THE DEAN
I HEREBY AUTHORIZE AND FULLY SUPPORT THE APPLICATION FOR PERMANEWNT RESIDENCE ON
BEHALF OF _____________________________________________________
Dean: _________________________________________________________________________
DEPARTMENT CONTACT: _______________________________________________________
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University of South Alabama Office of International Education
Alpha Hall South, Room 338 Mobile, AL 36688
Ph: 251-460-7104/ Email: visa@southalabama.edu
DEPARTMENT QUESTIONNAIRE
Department Name
_________________________________________________________________
Department Contact (name, Phone & email)
Employee name (Last, First, Middle)
_____________________________________________
____________________________________________________
Country of Citizenship _________________________________________________________________
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.)
________________________________
Brief non-technical description of duties ___________________________________________________
Work site address _____________________________________________________________________
Annual salary or hourly wage rate
____________________________________________________
Was the employee provided with a written offer of employment?
 Yes
No
If yes what date was the offer letter written?________________________________________________
Is this a teaching position?
 Yes
No
Was a recruitment effort undertaken?  Yes
No
DEPARTMENT CERTIFICATION
Employee name: _____________________________________________
USA Department: ______________________________________________ certifies that:
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.
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University of South Alabama Office of International Education
Alpha Hall South, Room 338 Mobile, AL 36688
Ph: 251-460-7104/ Email: visa@southalabama.edu
DEPARTMENT QUESTIONNAIRE (CONT’D)
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 as 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 USA and Departments’ business, future recruitment
practices and hiring of foreign nationals.
Certified by:
Authorized Department Contact:
Name: _______________________________ Signature: ___________________ Date:_________
COMMENTS IF ANY:
-
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University of South Alabama Office of International Education
Alpha Hall South, Room 338 Mobile, AL 36688
Ph: 251-460-7104/ Email: visa@southalabama.edu
JOB INFORMATION
Job Title: __________________________________________________________________________
Current wage: ________________________________________________________________________
Enter the basic hours of work required per week (full-time = 40 hrs) and overtime hours in accordance
with Federal law and area of employment. If overtime isn’t recognized, enter N/A.
# Of hours / week
______________________
Basic:
____________________________
Overtime:
________________________
Hourly work schedule From:
To:
(Enter the daily work schedule for the position
(e.g. 9a.m. to 5p.m.; 7a.m.to 11a.m. and 4p.m. to 8p.m).
Job title of Supervisor: ______________________________________________
Documentation about the Department’s Recruiting Efforts:
At least one nationwide professional journal posting (paper version, not online version) is required.
Media Name
Nature
Date of Posting
1. ___________
__________________
_____________
2. ___________
__________________
_____________
3. ___________
__________________
_____________
Additional recruitment efforts:
-
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University of South Alabama Office of International Education
Alpha Hall South, Room 338 Mobile, AL 36688
Ph: 251-460-7104/ Email: visa@southalabama.edu
Will the beneficiary supervise the work of others?
If yes, # of employees the beneficiary will
supervise, and job titles of the employees the beneficiary will supervise ; Enter “N/A” if you answered
“no” to the question above.
 YES
NO
Job duties: (Please attach it to this intake). Please describe the duties for the job to be performed.
Please add attachments to continue and complete description; describe in detail the job duties to be
performed by the beneficiary for the offered position. Specify any equipment to be used and pertinent
working conditions.____________________________________________________________
Will travel be required in order to perform the job duties?
If yes, please explain the travel
requirements; Enter “N/A” if you answered “no” to the question above.  YES
NO
Are there any other working conditions that affect the rate of pay?
working conditions;
If yes, please specify the
. YES
NO
Education: Minimum U.S. diploma/degree required
only mark 1 box; If other degree, specify the
diploma/degree required; i.e.: JD, MD or OD, DDS, etc.). If the answer to the question above is not
“other”, enter “N/A)
None
High School Associates
Bachelors
Masters
PhD
Other (JD, MD, etc.)
Is an equivalent foreign degree acceptable?
Must the degree be awarded by a U.S. Institution, or
would the Department consider candidates with the required degree or equivalent education earned
from an institution abroad?
 YES
NO
Indicate the major(s) and/or field(s) of
study required (you may list more than one related major and more than one field
Does the employer require a second U.S. degree?
equivalency apply
 YES
NO
foreign degree
Is training for the offered position required? ”training” refers to training that he beneficiary has
previously obtained to be qualified for the position. Training may include programs, coursework, a
medical residency program, or training experience other than employment.  YES
NO
Is employment experience required?
Training and experience do not refer to what is gained as a
graduate student. Generally no training or experience is required for an Assistant Professor position
beyond a Ph.D., unless the position requires a medical residency program.
 YES
NO
If “yes”, enter the # of months of training required:
______________________________
If yes, enter the occupation in which experience is required:
_______________________________
If yes, Is the employment experience required in the same position as that offered to the beneficiary
 Same
Different
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University of South Alabama Office of International Education
Alpha Hall South, Room 338 Mobile, AL 36688
Ph: 251-460-7104/ Email: visa@southalabama.edu
Is there an alternative combination of education and experience acceptable for the position?
 YES
NO
If yes, indicate the alternate level of education AND the alternate years of experience acceptable.
Special requirements: List specific skills, Licenses/certifications, and requirements of the offered
position. (Certifications, professional and/or medical licenses, knowledge of specific computer
languages or programs, specific foreign language proficiency, test results etc.)
Is knowledge of a foreign language required?
 YES
NO
If yes, specify the foreign language(s)
Worksite street address 1
Worksite street address 2
Worksite City:
Worksite County
Worksite Country
Worksite State and Zip code
Will work be performed in multiple locations within an area of intended employment or a location(s)
other than the address listed above?  YES
NO
If yes identify the geographic place(s) of
employment with as much specificity as possible. If necessary, submit an attachment to continue and
complete a listing of all anticipated worksites (address)
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