Migrant Labor Contractor Application Certificate of Registration

Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m), Wisconsin Statutes].

1. Application for:

A. Renewal

B. New Certification

2. Veteran Fee Waiver Eligibility Code:

* If you are a Veteran applying for a first-time certificate, you may be eligible for a one-time fee waiver. For more information on fee waiver go to http://dva.state.wi.us/Ben-FeeWaiver.asp.

3. Recuiter Name

First Name

Last Name

The South Central Wisconsin Job Centers are equal opportunity employer/program service providers. If you need assistance to access our services in a different language or need this material in an alternative format, contact us. Deaf, hard of hearing or speech impaired callers may reach us by using Wisconsin Relay Services at 711. Proud partners of the American Job Center network.

A proud partner of the American Job Center network