| CASE NUMBER | I-200-24291-414093 |
| CASE STATUS | Certified |
| RECEIVED DATE | 10/17/2024 |
| DECISION DATE | 10/24/2024 |
| 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 | 4/1/2025 |
| END DATE | 3/31/2028 |
| 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 | Washington County Regional Medical Center |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 610 Sparta Road |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | Sandersville |
| EMPLOYER STATE | GA |
| EMPLOYER POSTAL CODE | 31082 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 14782402277 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 622110 |
| EMPLOYER POC LAST NAME | White |
| EMPLOYER POC FIRST NAME | Tammy |
| EMPLOYER POC MIDDLE NAME | L. |
| EMPLOYER POC JOB TITLE | Human Resources Manager |
| EMPLOYER POC ADDRESS1 | 610 Sparta Road |
| EMPLOYER POC ADDRESS2 | |
| EMPLOYER POC CITY | Sandersville |
| EMPLOYER POC STATE | GA |
| EMPLOYER POC POSTAL CODE | 31082 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 14782402277 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | twhite@wcrmc.com |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Okura |
| AGENT ATTORNEY FIRST NAME | Masae |
| AGENT ATTORNEY MIDDLE NAME | |
| AGENT ATTORNEY ADDRESS1 | 1600 Parkwood Circle |
| AGENT ATTORNEY ADDRESS2 | Suite 200 |
| AGENT ATTORNEY CITY | Atlanta |
| AGENT ATTORNEY STATE | GA |
| AGENT ATTORNEY POSTAL CODE | 30339 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 16784264641 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | mokura@taylorenglish.com |
| LAWFIRM NAME BUSINESS NAME | Taylor English DUMA LLP |
| STATE OF HIGHEST COURT | GA |
| NAME OF HIGHEST STATE COURT | Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 610 Sparta Road |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Sandersville |
| WORKSITE COUNTY | WASHINGTON |
| WORKSITE STATE | GA |
| WORKSITE POSTAL CODE | 31082 |
| WAGE RATE OF PAY FROM | $64,937.60 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $35,256.00 |
| 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 | 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 | 2025-04-01 |
