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REQUEST FOR PREVAILING WAGE
State Form 48364 (R3 / 6-08) INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT

F OR E IG N L A B OR C E R T IF IC A T ION UNIT 10 N. S E NA T E A V E NUE , INDIA NA P OL IS , INDIA NA 46204-2277 P HONE : (317) 233-6681 F A X: (317) 234-2932

P L E A S E NOT E :

T his information provided here is for the purpos es of determining the P R E V A IL ING WA G E for the oc c upation lis ted. T his wage is required for c ertain immigration-related ac tivities . It is not valid for any other purpos e. A ll reques ted information mus t be provided or the reques t will be returned via U.S .P .S mail to obtain the mis s ing information.

1.

Name and addres s of pers on reques ting determination:

DWD-F L C T rac king Number:

2. 4. 5. 6. 7. 8. 9. 10.

F A X No.:

(

)

3. T elephone No.:

(

)

Name of E mployer: F ederal E mployer ID Number: C ity and C ounty propos ed employment

C ity

C ounty

If employer is a post-secondary institution, indicate discipline or school Nature of Employer's business: Job Title: Complete job description ( use additional sheet if necessary ):

11.

State in Detail the MINIMUM requirements for above position
College Degree required (specify) Major Field of Study

TRAINING:
Number of Years Number of Months Type of Training

EDUCATION: (enter number of years) E XP E R IE NC E : J ob Offered
Y ears

High School

College

Technical/Trade

R elated Oc c upation
Month Years Months Job T i t l e

12. 13. 14.

S pec ial requirements if any: Oc c upational title of worker's immediate s upervis or Number of employees worker will supervis e DO NOT MA K E A NY E NT R IE S B E L OW

T he prevailing wage for the above oc c upation in the area indic ated has been determined to be $ OE S /O-Net C ode Date of Determination: p er Level:
T HIS DE T E R MINA T ION IS V A L ID F OR NOT L E S S T HA N 90 DA Y S OR MOR E T HA N_______ F R OM T HE DA T E OF IS S UE (determination).