QUESTIONNAIRE FOR PERM SPONSOR

DATE THIS QUESTIONNAIRE IS BEING COMPLETED



NAME OF FOREIGN NATIONAL WHO IS BEING SPONSORED



FULL LEGAL NAME OF EMPLOYER (please include exact punctuation, capitalized letters, etc. where appropriate)



COMPLETE ADDRESS OF EMPLOYER’S HEADQUARTERS (including suite #, street address, city, state, zip)



ADDRESS OF BRANCH OFFICE WHERE FOREIGN NATIONAL WILL BE EMPLOYED:
Company name (if different – including suite #, street address, city, state, zip)



County (please note that this says “county”, not “country”!) in which the job site is located



INFORMATION FOR CONTACT PERSON AT YOUR COMPANY (Note: the DOL may contact this person for information about the case; therefore, this should be a person who is in a position to communicate both with our office and with the DOL)
Name:

Company title:

Work telephone number:

Mobile telephone number:

FAX number:

Email address:



INFORMATION ABOUT THE PERSON AT WHO WILL BE SIGNING THE FORMS (Note: this person will, in some instances, be different from the Contact Person)
Name:

Company title:

Email address:

Work telephone number:



FEDERAL EMPLOYER IDENTIFICATION NUMBER (EIN)



STATE UNEMPLOYMENT AGENCY EMPLOYER ACCT NUMBER



DATE THE COMPANY WAS ESTABLISHED



NATURE OF EMPLOYER’S BUSINESS



NUMBER OF COMPANY EMPLOYEES:
1.Company wide:

2.At the branch office where the foreign national will be working (or out of which the foreign national will be working):



DOES YOUR COMPANY HAVE AN EMPLOYEE REFERRAL PROGRAM?yesno


WITHIN THE PAST 6 MONTHS, HAS YOUR COMPANY HAD A LAYOFF IN THE GEOGRAPHICAL AREA WHERE THE FOREIGN NATIONAL WILL BE WORKING?yesno


ARE YOU A FEDERAL CONTRACTOR?yesno


IS PREFFRENCE GIVEN TO VETERANS FOR THIS POSITION:yesno


IS THIS A “GREEN JOB”?yesno


IS THIS JOB OPPORTUNITY FOR WORK SUBSIDIZED BY THE AMERICAN RECOVERY & REINVESTMENT ACT?yesno


WHICH OF THE FOLLOWING TESTS/CHECKS (IF ANY) DO YOU REQUIRE OF NEW HIRES?
Drug testing/screeningBackground checksCredit checksReference checksBondingMotor vehicle record check
Other (specify):



WHICH OF THE FOLLOWING BENEFITS ARE OFFERED FOR THE JOB?
MedicalSick LeaveRelocation AssistanceDentalTuition assistanceUniform AllowanceLife InsuranceJob ShareCompany VehicleVisionFlex-TimeChild Care401KShort/Long Term DisabilityVacationStock OptionsExpense AccountHolidaysRetirement/Pension
Other (describe below*)



*Brief description of other benefits you may offer:



IS THIS JOB ACCESSIBLE BY PUBLIC TRANSPORTATION?yesno


IS THIS JOB IN AN ENTERPRISE ZONE (a specific geographic area targeted for economic revitalizing)?yesno


FOREIGN NATIONAL’S JOB TITLE



FOREIGN NATIONAL’S WORK SCHEDULE



FOREIGN NATIONAL’S CURRENT RATE OF PAY



PAY RANGE OF EMPLOYEES SIMILARLY EMPLOYED



JOB TITLE OF THE PERSON WHO WILL BE SUPERVISING THE FOREIGN NATIONAL



VERY DETAILED DESCRIPTION OF THE JOB DUTIES (OR TYPES OF JOB DUTIES)
THAT THIS POSITION WILL ENCOMPASS OVER THE COURSE OF THE NEXT FEW YEARS (minimum 1 long paragraph – if easier, please attach a separate page with the job description as a Word document)



HOW MANY COMPANY EMPLOYEES DOES (OR WILL) THIS FOREIGN NATIONAL SUPERVISE?



COMPANY’S MINIMUM EDUCATION REQUIREMENTS FOR THIS POSITION
Level of degree (Bachelor’s, Master’s, etc.):

Major field of study:



COMPANY’S MINIMUM NUMBER OF YEARS OF EXPERIENCE REQUIRED FOR THIS POSITION



COMPUTER SKILLS REQUIRED (software packages, etc. – note that these should only be computer skills that the foreign national had before being hired by your company)



ANY OTHER SPECIAL REQUIREMENTS FOR THIS POSITION



MACHINES AND/OR TOOLS USED IN THE PERFORMANCE OF THE DUTIES



IF THERE ARE MULTIPLE POSITIONS AVAILABLE IN THIS JOB TITLE, HOW MANY POSITIONS ARE AVAILABLE?yesno



WILL TRAVEL BE REQUIRED IN ORDER TO PERFORM THE JOB DUTIES? If yes, explain the travel requirementsyesno



ARE THERE ANY OTHER WORKING CONDITIONS THAT AFFECT THE RATE OF PAY? If yes, specify themyesno



WILL THE WORK BE PERFORMED IN MULTIPLE WORKSITES? If yes, list addresses of all intended worksitesyesno