O MB
	Approval: 1205-0451
MB
	Approval: 1205-0451
Expiration Date: 05/31/2021
Application for Permanent Employment Certification
Form ETA-9089 – Appendix B: Additional Worksite Information
U.S. Department of Labor
	
	
ADDITIONAL WORKSITE INFORMATION
Additional Worksite 1 §
| 1. County | 2. State/District/Territory 
 | |
| 3. MSA/OES Area Code 
 | 3a. MSA Name/OES Area Title | |
Additional Worksite 2 §
| 1. County 
 | 2. State/District/Territory 
 | |
| 3. MSA/OES Area Code 
 | 3a. MSA Name/OES Area Title | |
Additional Worksite 3 §
| 1. County 
 | 2. State/District/Territory 
 | |
| 3. MSA/OES Area Code 
 | 3a. MSA Name/OES Area Title | |
Additional Worksite 4 §
| 1. County 
 | 2. State/District/Territory 
 | |
| 3. MSA/OES Area Code 
 | 3a. MSA Name/OES Area Title | |
Additional Worksite 5 §
| 1. County 
 | 2. State/District/Territory 
 | |
| 3. MSA/OES Area Code 
 | 3a. MSA Name/OES Area Title | |
For Public Burden Statement, see the Instructions for Form ETA-9089.
	
	
	Form
	ETA-9089 – Appendix B	            FOR DEPARTMENT OF LABOR USE
	ONLY	                               Page
	B.
	
	
PERM Case Number: ___________________ Case Status: __________________ Determination Date: ______________ Expiration Date: ______________
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document | 
| Author | Melanie Shay | 
| File Modified | 0000-00-00 | 
| File Created | 2021-04-30 |