PERM Questionnaire

1. Employer’s Headquarters or Main Office Information

Employer Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email

Number of Employees

Date Established

Employer Tax ID (EIN)

NAICS Code

Does the foreign national have an ownership interest in or a familial relationship with the employer in any manner?

2. Job Opportunity Information (Worksite Information)

Occupation Title

Salary (Specify per hour or per year)

First

Last

Job Site Address

Address Line 1

Address Line 2

City

State

Zip Code

Is there a union representative that needs to be contacted regarding this application?

Has the employer had a layoff in the area of intended employment in the past 6 months?

If yes, please specify the date.

3. Foreign National Information

Name

First

Middle

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number

Email

Country of Citizenship

Country of Birth

Date of Birth

Class of Admission

Alien Registration Number (A #)

I-94 Number

Highest Level of Education Achieved

Field of Study

Year Education Completed

Conferring Institution Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Are you currently employed by the petitioning employer?

4. Foreign National Work Experience during the past 3 years

Employer Name

Job 1

Address

Address Line 1

Address Line 2

City

State

Zip Code

Type of Business

Job Title

Start Date

End Date

Number of hours per week

Employer Name

Job 2

Address

Address Line 1

Address Line 2

City

State

Zip Code

Type of Business

Job Title

Start Date

End Date

Number of hours per week

Employer Name

Job 3

Address

Address Line 1

Address Line 2

City

State

Zip Code

Type of Business

Job Title

Start Date

End Date

Number of hours per week

Employer Name

Job 4

Address

Address Line 1

Address Line 2

City

State

Zip Code

Type of Business

Job Title

Start Date

End Date

Number of hours per week

Employer Name

Job 5

Address

Address Line 1

Address Line 2

City

State

Zip Code

Type of Business

Job Title

Start Date

End Date

Number of hours per week

5. Enter the information of the person submitting this questionnaire.

Name *

Email *

PERM Questionnaire

For Labor Certification

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