| CASE NUMBER | I-200-25069-761408 |
| CASE STATUS | Certified |
| RECEIVED DATE | 3/10/2025 |
| DECISION DATE | 3/17/2025 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | General Manager |
| SOC CODE | 11-1021.00 |
| SOC TITLE | General and Operations Managers |
| FULL TIME POSITION | Y |
| BEGIN DATE | 9/8/2025 |
| END DATE | 9/7/2028 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 1 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| EMPLOYER NAME | Hollywood Golf Club |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 510 Roseld Avenue |
| EMPLOYER ADDRESS2 | N/A |
| EMPLOYER CITY | Deal |
| EMPLOYER STATE | NJ |
| EMPLOYER POSTAL CODE | 7723 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 17325310900 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 713910 |
| EMPLOYER POC LAST NAME | Bryk |
| EMPLOYER POC FIRST NAME | Mary |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | Controller |
| EMPLOYER POC ADDRESS1 | 510 Roseld Avenue |
| EMPLOYER POC ADDRESS2 | |
| EMPLOYER POC CITY | Deal |
| EMPLOYER POC STATE | NJ |
| EMPLOYER POC POSTAL CODE | 7723 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 17325310900 |
| EMPLOYER POC PHONE EXT | 44 |
| EMPLOYER POC EMAIL | mary@hollywoodgolfclub.com |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Pabian |
| AGENT ATTORNEY FIRST NAME | Keith |
| AGENT ATTORNEY MIDDLE NAME | Andrew |
| AGENT ATTORNEY ADDRESS1 | 40 Speen Street |
| AGENT ATTORNEY ADDRESS2 | 4th Floor |
| AGENT ATTORNEY CITY | Framingham |
| AGENT ATTORNEY STATE | MA |
| AGENT ATTORNEY POSTAL CODE | 1701 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | N/A |
| AGENT ATTORNEY PHONE | 16179399444 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | keith.pabian@pabianlaw.com |
| LAWFIRM NAME BUSINESS NAME | Pabian Law, LLC |
| STATE OF HIGHEST COURT | MA |
| NAME OF HIGHEST STATE COURT | Supreme Judicial Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 510 Roseld Avenue |
| WORKSITE ADDRESS2 | N/A |
| WORKSITE CITY | Deal |
| WORKSITE COUNTY | MONMOUTH |
| WORKSITE STATE | NJ |
| WORKSITE POSTAL CODE | 7723 |
| WAGE RATE OF PAY FROM | $285,000.00 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $233,397.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | IV |
| PW OES YEAR | 7/1/2024 - 6/30/2025 |
| 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 | 2025-09-08 |
