U.S. DOL Form dol-swa-misssissipi-pwd
Mississippi Department of Employment Security Prevailing Wage Information Request Requestor Name: (First, MI, Last Name)
Fax Number: (Area Code & No.
1. Name of employer (Full name of organization)
2. Telephone: (Area Code & No.)
3. Address (Number, Street, City or Town, County, State, Zip Code)
4. Name of alien (if known)
5. Address where alien will work (if different from item 3)
6. Nature of employer’s business
7. Alien’s job title
8. Work shift
9. Rate of pay
$
per
10. Describe fully the job to be performed (Duties and Special Requirements)
11. Which level best describes this occupation? (Check the appropriate box)
SKILL LEVEL 1
SKILL LEVEL II
1. Basic understanding of occupation
2. Limited exercise of judgment
3. Works under close supervision and receives special
instructions
4. Work is closely monitored and reviewed for
accuracy.
1. Advanced skills and diversified knowledge
2. Plans and conducts work requiring judgement and
independent evaluation.
3. May supervise or provide direction to other staff.
4. Receives only technical guidance.
5. Work reviewed for application of sound judgement and
effectiveness.
12. College Education (Enter number of years)
College Degree required (Specify)
Specify Specialty ________________________
14. Number of employees alien will supervise: _____
13. Experience required
15. Occupational title of person who will be alien’s immediate
supervisor: ___________________________________
years
months
Return to:
Mississippi Department of Employment Security
Jane Smith
P.O. Box 1699
Jackson, Mississippi 39215-1699
Phone Number: (601) 321-6104
Fax Number: (601) 321-6080
*****FOR OFFICIAL USE ONLY – DO NOT WRITE BELOW THIS LINE*****
The prevailing wage for the job described is : $
per
Source of wage finding:
By: __________________________________ Date: ________________________
(LMI Report Section)
CASE NO:
THIS RATE IS VALID FOR FILING APPLICATIONS AND ATTESTATIONS
FOR 90 DAYS FROM THE DATE OF THIS RESPONSE.
Mississippi Department of Employment Security is an equal opportunity employer.
Auxiliary aids and services are available upon request to individuals with disabilities.
Revised 03/98