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Employer Name
Mailing Address
Business Location Telephone & Cell Number Fax Number Email address
REPORT SUMMARY
Total Laborers/Helpers
Total
EMPLOYER CERTIFICATION
I , __________________________, hereby certify that the information contained in this Employer’s Workplace Monthly
Report is true and correct. I understand that it is a violation of law to knowingly submit false or misleading information
on this report or any attachments thereto. I also understand that if this report was filed electronically, the absence of
my signature below does not absolve me from being held liable for the accuracy and timely submission of this report.
Title:__________________________________ Date:___________________________________
Pursuant to 17 GAR § 7110, employers who employ H-2B workers in Guam must complete this report and submit it to the Department of Labor no
later than the 7th of each month. The report must show a true and accurate accounting of the employer’s workforce activities for the calendar month
immediately preceding. Failure to submit the report in a timely manner may result in fines up to $500.00 for first offenses and up to $25,000.00 for
repeated violations.
Effective 1/1/07, employers may submit this report via fax or email, provided that they have first submitted a notarized ALPCD Electronic Filing
Authorization. Employers who file electronically are still responsible for verifying that ALPCD received their electronically filed report. Electronic
filings will be accepted in Microsoft Word, Excel or PDF file formats only.
You may elect to automate this report, however, reports must be submitted in the prescribed layout and may be rejected should you modify the
layout. Reports with missing information or in the wrong format may be rejected and returned for correction
U.S. WORKFORCE DATA
eForm -ALPCD01