| CASE NUMBER | I-200-24265-355113 |
| CASE STATUS | Certified |
| RECEIVED DATE | 9/20/2024 |
| DECISION DATE | 9/27/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Senior Principal Signal Integrity Engineer |
| SOC CODE | 17-2071.00 |
| SOC TITLE | Electrical Engineers |
| FULL TIME POSITION | Y |
| BEGIN DATE | 11/1/2024 |
| END DATE | 10/31/2027 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 1 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| EMPLOYER NAME | FormFactor, Inc. |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 7005 Southfront Road |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | Livermore |
| EMPLOYER STATE | CA |
| EMPLOYER POSTAL CODE | 94551 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | +19252904000 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 33441 |
| EMPLOYER POC LAST NAME | Monnig |
| EMPLOYER POC FIRST NAME | Jennifer |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | Director, People Operations & Transformation |
| EMPLOYER POC ADDRESS1 | 7005 Southfront Road |
| EMPLOYER POC ADDRESS2 | |
| EMPLOYER POC CITY | Livermore |
| EMPLOYER POC STATE | CA |
| EMPLOYER POC POSTAL CODE | 94551 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | +15036011836 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | jennifer.monnig@formfactor.com |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Drummond |
| AGENT ATTORNEY FIRST NAME | Ilana |
| AGENT ATTORNEY MIDDLE NAME | J. |
| AGENT ATTORNEY ADDRESS1 | 909 Montgomery St |
| AGENT ATTORNEY ADDRESS2 | Suite 200 |
| AGENT ATTORNEY CITY | San Francisco |
| AGENT ATTORNEY STATE | CA |
| AGENT ATTORNEY POSTAL CODE | 94133 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | CA |
| AGENT ATTORNEY PHONE | +14159864559 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | idrummond@jackson-hertogs.com |
| LAWFIRM NAME BUSINESS NAME | Jackson & Hertogs LLP |
| STATE OF HIGHEST COURT | CA |
| NAME OF HIGHEST STATE COURT | CA Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 7005 Southfront Road |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Livermore |
| WORKSITE COUNTY | ALAMEDA |
| WORKSITE STATE | CA |
| WORKSITE POSTAL CODE | 94551 |
| WAGE RATE OF PAY FROM | 136,200.00 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | $204,400.00 |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $124,842.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | II |
| PW OES YEAR | 7/1/2024 - 6/30/2025 |
| PW OTHER SOURCE | |
| PW OTHER YEAR | |
| PW SURVEY PUBLISHER | |
| PW SURVEY NAME | |
| TOTAL WORKSITE LOCATIONS | 2 |
| AGREE TO LC STATEMENT | Yes |
| H 1B DEPENDENT | No |
| WILLFUL VIOLATOR | No |
| SUPPORT H1B | N/A |
| STATUTORY BASIS | |
| APPENDIX A ATTACHED | N/A |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | Rivadeneyra 88560 |
| PREPARER FIRST NAME | Michelle |
| PREPARER MIDDLE INITIAL | C |
| PREPARER BUSINESS NAME | Jackson & Hertogs LLP |
| PREPARER EMAIL | mchu@jackson-hertogs.com |
| BEGIN DATE CONVERTED | 2024-01-11 |
