Labor statistics department: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the Employer Information section. Enter the employer's name, address, telephone number, and Federal ID Number (EIN) in Boxes 3-5.
Next, complete the Applicant Information section. In Boxes 6-8, provide the applicant's name and Social Security Number. Indicate if they have worked for this employer before and include the last date of employment if applicable.
Proceed to the Applicant Characteristics section (Boxes 12-23). Carefully read each question and answer accordingly. Provide additional information where requested, especially for eligibility documentation.
In Box 24, list any sources used to document eligibility based on your answers in Boxes 12-23. Ensure you indicate whether documents are attached or forthcoming.
Finally, sign the form in Box 25(a) and indicate who signed it in Box 25(b). Enter the date of completion in Box 26.

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