HR LCA Approved Form

HR LCA APPROVED FORM

I. Case and Position Identification

Employer Name:

LCA Case Number:    Visa Classification:

Job Title:    Department:

Period of Employment (LCA): From to

II. Wage and Prevailing Wage Determination

Offered Wage: $ per year    Wage Basis:

Hours per Week:    Overtime Eligible: Yes

III. Recruitment and Posting

Recruitment Steps Completed (check all that apply):

Internal job notice posted at worksite    External job board posting

Local newspaper/advertisement    Use of recruiter / third party

IV. Compliance Attestations (Employer)

By initialing and signing below the employer attests to the following required certifications under the Labor Condition Application. These attestations are material statements and civil and criminal penalties may apply for knowing and willful misrepresentations.

The employer will pay the required wage to the beneficiary during the period of employment.    The employment of the beneficiary will not adversely affect the working conditions of workers similarly employed.

There is no strike or lockout at the place of employment.    Notice of the LCA was posted at the worksite in accordance with LCA posting requirements.

V. Documentation & Attachments

Attachments provided with this approval (check all that apply):

Copy of certified LCA    Prevailing wage determination

Proof of posting/notice    Recruitment record and resumes reviewed

VI. Candidate Information and HR Onboarding Data

Phone:    Email:

VII. Employment History

Title:    Dates Employed:

Title:    Dates Employed:

VIII. Education

Degree:    Institution:

Graduation Date:

IX. References

Phone:    Email:

Phone:    Email:

Phone:    Email:

X. Legal Disclosures and Authorizations

At-Will Employment: Nothing in this document constitutes an express or implied employment contract. Employment relationships are at-will and either the employer or the employee may terminate the employment relationship at any time, with or without cause or prior notice, unless otherwise agreed in writing by authorized representatives.

Equal Employment Opportunity: The employer is an equal opportunity employer. Employment decisions are made without regard to race, color, religion, sex, national origin, age, disability, protected veteran status, or any other characteristic protected by applicable law.

Authorization to Verify: I authorize the Employer and its agents to contact prior employers, educational institutions, and references to verify information provided and to conduct background and security checks as required for employment and immigration compliance. I understand that background checks may include criminal, credit, and employment verification as permitted by law.

Applicant Consent: I consent to the authorizations above and certify that the information I have provided is true, complete, and correct to the best of my knowledge.

Applicant Printed Name:    Date:

XI. HR Determination and Approval

HR Review Notes (compliance findings, conditions, and any corrective actions required prior to start):

HR Certifies that the LCA has been reviewed and all internal compliance steps required by the company have been completed. HR Representative confirms the LCA wage matches payroll setup and applicable job classification.

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