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                         PERM Labor Certification Evaluation Questionnaire-
                                       Optional Special Recruitment (OSR)

I. Information about Employer

School Name ___________________________________________

County & State of the place of Employment _______________

II. Information about Job Offered

1. Job title ____________________________________

2. Basic annual salary ____________________

3. Description of job duties: _______________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

4. Minimum requirements

Degree level (Bachelor’s, Master’s, Doctoral) __________________

Field of study ________________

Experience _________________________ (year/month)

5. Name of the print media in which the position was advertised: ____________________________

____________________________________ (Please attach a copy of the advertisement if available)

6. Dates of the print advertisement: ___________________________________

7. Date of the employment determination: _____________________________ (Please attach a copy of
the offer letter if available)

Please email the completed Evaluation Questionnaire and your resume to zliu@niwus.com for a
free evaluation. As an alternative, you may download and complete the Questionnaire, and fax
it to (713) 974-3463.

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