Form - Specialty Crop H-2A | employment company with h2a visa

AGRICULTURAL LABOR INFORMATION FORM

1. Company Name or DBA

Company Federal ID Number

Entity Type (please circle one)

2. Company Physical Address

Company mailing Address (If different)

Company Worksite Locations (please list all addresses, land parcel names, or GPS coordinates; attach additional sheets as necessary)

3. Contact Person(s)

Phone Numer(s)

Cell Numer(s)

Fax Numer(s)

Email(s)

4. Number of Workers Needed per Target Date(s) of Need

Preferred Target Date(s) of Need

Length or target Date(s) of Need

Work Shift(s) for Workers

Estimated Worker Hours per Workweek

Please briefly describe your business and the tasks to be performed (attach additional sheets as necessary)

Equipment Operation Skills Needed (attach additional sheets as necessary)

Please provide other information that could help us identify and train prospective workers

I herebry consent to the processing of the data that I have provided to respond to my request

Specialty Crop Farm Labor Contractors, LLC

P.O. Box 195
Vergennes, VT 05491

Phone: 315-986-4738
Fax: 802-329-2217
Email: contact@specialtycroph2a.com