| CASE NUMBER | I-200-23312-487871 |
| CASE STATUS | Certified |
| RECEIVED DATE | 11/8/2023 |
| DECISION DATE | 11/16/2023 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Medical Technologist |
| SOC CODE | 29-2011.00 |
| SOC TITLE | Medical and Clinical Laboratory Technologists |
| FULL TIME POSITION | Y |
| BEGIN DATE | 1/1/2024 |
| END DATE | 12/30/2026 |
| 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 | Navajo Health Foundation Sage Memorial Hospital |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | SR 264 & HWY 191 South |
| EMPLOYER ADDRESS2 | P.O. Box 457 |
| EMPLOYER CITY | Ganado |
| EMPLOYER STATE | AZ |
| EMPLOYER POSTAL CODE | 86505 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 19287554552 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 622110 |
| EMPLOYER POC LAST NAME | Etsitty |
| EMPLOYER POC FIRST NAME | Jolene |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | Human Resources Director |
| EMPLOYER POC ADDRESS1 | SR 264 & HWY 191 South |
| EMPLOYER POC ADDRESS2 | |
| EMPLOYER POC CITY | Ganado |
| EMPLOYER POC STATE | AZ |
| EMPLOYER POC POSTAL CODE | 86505 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 19287554552 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | Jolene.etsitty@sagememorial.com |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Koren |
| AGENT ATTORNEY FIRST NAME | Gali |
| AGENT ATTORNEY MIDDLE NAME | |
| AGENT ATTORNEY ADDRESS1 | PO Box 53036 |
| AGENT ATTORNEY ADDRESS2 | |
| AGENT ATTORNEY CITY | Irvine |
| AGENT ATTORNEY STATE | CA |
| AGENT ATTORNEY POSTAL CODE | 92619 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 19496238707 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | gali@korenimmigratino.com |
| LAWFIRM NAME BUSINESS NAME | Law Offices of Gali Koren |
| STATE OF HIGHEST COURT | CA |
| NAME OF HIGHEST STATE COURT | Supreme Court of California |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | US 191 and SR 264 |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Ganado |
| WORKSITE COUNTY | NAVAJO |
| WORKSITE STATE | AZ |
| WORKSITE POSTAL CODE | 86505 |
| WAGE RATE OF PAY FROM | 33758 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $33,758.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | I |
| PW OES YEAR | 7/1/2023 - 6/30/2024 |
| PW OTHER SOURCE | |
| PW OTHER YEAR | |
| PW SURVEY PUBLISHER | |
| PW SURVEY NAME | |
| TOTAL WORKSITE LOCATIONS | 1 |
| 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 and Employment |
| PREPARER LAST NAME | koren |
| PREPARER FIRST NAME | gali |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | law offices of gali koren |
| PREPARER EMAIL | gali@Korenimmigration.com |
| BEGIN DATE CONVERTED | 2024-01-01 |
