| CASE NUMBER | I-200-24300-435018 |
| CASE STATUS | Certified |
| RECEIVED DATE | 10/26/2024 |
| DECISION DATE | 11/1/2024 |
| 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 | Y |
| BEGIN DATE | 1/20/2025 |
| END DATE | 1/19/2028 |
| 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 | Calhoun Liberty Hospital Association, Inc. |
| TRADE NAME DBA | Calhoun Liberty Hospital |
| EMPLOYER ADDRESS1 | 20370 NE Burns Ave. |
| EMPLOYER ADDRESS2 | P.O. Box 419 |
| EMPLOYER CITY | Blountstown |
| EMPLOYER STATE | FL |
| EMPLOYER POSTAL CODE | 32424 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 18506745411 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 622110 |
| EMPLOYER POC LAST NAME | Griner |
| EMPLOYER POC FIRST NAME | Ginny |
| EMPLOYER POC MIDDLE NAME | |
| EMPLOYER POC JOB TITLE | HR Director & Medical Staff Credentialing |
| EMPLOYER POC ADDRESS1 | 20370 NE Burns Ave. |
| EMPLOYER POC ADDRESS2 | P.O. Box 419 |
| EMPLOYER POC CITY | Blountstown |
| EMPLOYER POC STATE | FL |
| EMPLOYER POC POSTAL CODE | 32424 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 18506745411 |
| EMPLOYER POC PHONE EXT | 208 |
| EMPLOYER POC EMAIL | GGriner@clhcares.org |
| 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 | 20370 NE Burns Ave. |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Blountstown |
| WORKSITE COUNTY | CALHOUN |
| WORKSITE STATE | FL |
| WORKSITE POSTAL CODE | 32424 |
| WAGE RATE OF PAY FROM | $33.00 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Hour |
| PREVAILING WAGE | $27.42 |
| PW UNIT OF PAY | Hour |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | III |
| 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 | 2025-01-20 |
