| CASE NUMBER | I-200-24131-983582 |
| CASE STATUS | Certified |
| RECEIVED DATE | 5/10/2024 |
| DECISION DATE | 5/17/2024 |
| 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 | N |
| BEGIN DATE | 6/24/2024 |
| END DATE | 2/27/2027 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 1 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| EMPLOYER NAME | North Walton Rural Hospital, LLC |
| TRADE NAME DBA | North Walton Doctors Hospital |
| EMPLOYER ADDRESS1 | 4413 US Highway 331 South |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | DeFuniak Springs |
| EMPLOYER STATE | FL |
| EMPLOYER POSTAL CODE | 32435 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 18509202065 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 622110 |
| EMPLOYER POC LAST NAME | Stanley |
| EMPLOYER POC FIRST NAME | Elizabeth |
| EMPLOYER POC MIDDLE NAME | A. |
| EMPLOYER POC JOB TITLE | Director of Human Resources |
| EMPLOYER POC ADDRESS1 | 4413 US Highway 331 South |
| EMPLOYER POC ADDRESS2 | |
| EMPLOYER POC CITY | DeFuniak Springs |
| EMPLOYER POC STATE | FL |
| EMPLOYER POC POSTAL CODE | 32435 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 18509202065 |
| EMPLOYER POC PHONE EXT | 1002 |
| EMPLOYER POC EMAIL | estanley@nwdhospital.com |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Tungol |
| AGENT ATTORNEY FIRST NAME | Renato |
| AGENT ATTORNEY MIDDLE NAME | Dumagan |
| AGENT ATTORNEY ADDRESS1 | 7705 Farmingdale Drive |
| AGENT ATTORNEY ADDRESS2 | |
| AGENT ATTORNEY CITY | Darien |
| AGENT ATTORNEY STATE | IL |
| AGENT ATTORNEY POSTAL CODE | 60561 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 16309208983 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | raytungol@gmail.com |
| LAWFIRM NAME BUSINESS NAME | Tungol Law Office |
| STATE OF HIGHEST COURT | MI |
| NAME OF HIGHEST STATE COURT | Michigan Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 4413 US Highway 331 South |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | DeFuniak Springs |
| WORKSITE COUNTY | WALTON |
| WORKSITE STATE | FL |
| WORKSITE POSTAL CODE | 32435 |
| WAGE RATE OF PAY FROM | 40 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Hour |
| PREVAILING WAGE | $27.30 |
| PW UNIT OF PAY | Hour |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | III |
| 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 |
| PREPARER LAST NAME | |
| PREPARER FIRST NAME | |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | |
| PREPARER EMAIL | |
| BEGIN DATE CONVERTED | 2025-12-06 |
