| CASE NUMBER | I-200-24236-289430 |
| CASE STATUS | Certified |
| RECEIVED DATE | 8/23/2024 |
| DECISION DATE | 8/30/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Assistant Professor & Family Medicine Physician |
| SOC CODE | 29-1215.00 |
| SOC TITLE | Family Medicine Physicians |
| FULL TIME POSITION | Y |
| BEGIN DATE | 9/23/2024 |
| END DATE | 9/22/2027 |
| 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 | East Tennessee State University (ETSU) |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | PO Box 70285 |
| EMPLOYER ADDRESS2 | 1276 Gilbreath Drive |
| EMPLOYER CITY | Johnson City |
| EMPLOYER STATE | TN |
| EMPLOYER POSTAL CODE | 37614 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | +14234398550 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 611310 |
| EMPLOYER POC LAST NAME | Weaver |
| EMPLOYER POC FIRST NAME | Carly |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | Staff Attorney |
| EMPLOYER POC ADDRESS1 | Office of University Counsel |
| EMPLOYER POC ADDRESS2 | PO Box 70285, 1276 Gilbreath Drive |
| EMPLOYER POC CITY | Johnson City |
| EMPLOYER POC STATE | TN |
| EMPLOYER POC POSTAL CODE | 37614 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | +14234398561 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | WEAVERCS@mail.etsu.edu |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Arroyo |
| AGENT ATTORNEY FIRST NAME | L. Mabel |
| AGENT ATTORNEY MIDDLE NAME | |
| AGENT ATTORNEY ADDRESS1 | 1600 West End Ave. |
| AGENT ATTORNEY ADDRESS2 | Suite 2000 |
| AGENT ATTORNEY CITY | Nashville |
| AGENT ATTORNEY STATE | TN |
| AGENT ATTORNEY POSTAL CODE | 37203 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | +16157267387 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | marroyo@bakerdonelson.com |
| LAWFIRM NAME BUSINESS NAME | Baker, Donelson, Bearman, Caldwell, Berkowitz, PC |
| STATE OF HIGHEST COURT | TN |
| NAME OF HIGHEST STATE COURT | Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | Johnson City Family Medicine Clinic, 917 West Walnut St. |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Johnson City |
| WORKSITE COUNTY | WASHINGTON |
| WORKSITE STATE | TN |
| WORKSITE POSTAL CODE | 37604 |
| WAGE RATE OF PAY FROM | 208,000.00 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $64,376.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | I |
| PW OES YEAR | 7/1/2024 - 6/30/2025 |
| PW OTHER SOURCE | |
| PW OTHER YEAR | |
| PW SURVEY PUBLISHER | |
| PW SURVEY NAME | |
| TOTAL WORKSITE LOCATIONS | 5 |
| 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 | 2025-11-09 |
