Eta form 9062-2025

1. Click ‘Get Form’ to open the ETA Form 9062 in the editor.
2. Begin by filling out Box 1 with the Initiating Agency Code, which is for agency use only. If applicable, check whether it’s a Participating Agency or SWA/DLA.
3. In Box 2, enter the Control Number assigned by the participating agency or SWA/DLA for internal tracking.
4. For Box 3, indicate whether this is an Original or Revalidation certification by checking the appropriate box.
5. If applicable, complete Box 4 for Ex-Felon Target Group details, including conviction and release dates.
6. Fill in Box 5 with the date you completed this form (month, day, year).
7. In Box 6, provide the name and address of the State Workforce Agency responsible for certification requests.
8. Sign in Box 7 as an authorized official and include your telephone number in Box 8.
9. Proceed to Part I: Enter the applicant's full name in Box 9 and their Social Security Number in Box 10.
10. Complete Boxes 11 through 13 with the applicant's address, target group code, and signature.
11. Finally, fill out Part II: Employer Declaration by providing firm details and signatures as required in Boxes 15 to 20.

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