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Get DoL ETA 9061 2009

Ber 30, 2011 2. Date Received (For Agency Use only) EMPLOYER INFORMATION 4. Employer Address and Telephone 5. Employer Federal ID Number (EIN) 1. Control No. (For Agency use only) APPLICANT INFORMATION 3. Employer Name APPLICANT INFORMATION 6. Applicant Name (Last, First, MI) 7. Social Security Number. 8. Have you worked for this employer before? Yes ____ No ____ If YES, enter last date of employment: ____________ APPLICANT CHARACTERISTICS FOR WOTC TARGET GROUP CERTIFICATION 9. Employme.

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