| LCA CASE NUMBER | I-200-21134-315367 |
| STATUS | Certified |
| LCA CASE SUBMIT | 2021-05-14 |
| DECISION DATE | 2021-05-21 |
| VISA CLASS | H-1B |
| LCA CASE JOB TITLE | DENTIST-GENERAL |
| SOC CODE | 29-1021.00 |
| SOC TITLE | Dentists, General |
| FULL TIME POSITION | True |
| LCA CASE EMPLOYMENT START DATE | 2021-10-01 |
| END DATE | 2024-09-30 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 1 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| LCA CASE EMPLOYER NAME | Ellen Polsky DDS & Bobby Virk DMD PS |
| TRADE NAME DBA | ADC Kids Dentistry |
| EMPLOYER ADDRESS1 | 34704 11th PL S |
| EMPLOYER ADDRESS2 | Suite 101 |
| EMPLOYER CITY | Federal Way |
| EMPLOYER STATE | WA |
| EMPLOYER POSTAL CODE | 98003 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 12064867691 |
| NAICS CODE | 621210 |
| EMPLOYER POC LAST NAME | Polsky |
| EMPLOYER POC FIRST NAME | Ellen |
| EMPLOYER POC JOB TITLE | Chief Executive Officer(CEO) |
| EMPLOYER POC ADDRESS 1 | 9317 113th Street East |
| EMPLOYER POC ADDRESS 2 | Suite A |
| EMPLOYER POC CITY | Puyallup |
| EMPLOYER POC STATE | WA |
| EMPLOYER POC POSTAL CODE | 98373 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 16177923007 |
| EMPLOYER POC EMAIL | ellen@visioteam.net |
| AGENT REPRESENTING EMPLOYER | True |
| AGENT ATTORNEY LAST NAME | Baxley |
| AGENT ATTORNEY FIRST NAME | Shirley |
| AGENT ATTORNEY ADDRESS1 | 2121 W JESTER WAY |
| AGENT ATTORNEY CITY | POST FALLS |
| AGENT ATTORNEY STATE | ID |
| AGENT ATTORNEY POSTAL CODE | 83854 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PHONE | 17143288090 |
| AGENT ATTORNEY EMAIL ADDRESS | shirley.baxley@sbcglobal.net |
| LAWFIRM NAME BUSINESS NAME | Shirley's Immigration Service |
|
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | False |
| WORKSITE ADDRESS1 | 34704 11th Place S |
| WORKSITE ADDRESS2 | Suite 101 |
| LCA CASE WORKLOC1 CITY | Federal Way |
| WORKSITE COUNTY | KING |
| LCA CASE WORKLOC1 STATE | WA |
| WORKSITE POSTAL CODE | 98003 |
| LCA CASE WAGE RATE FROM | 96928 |
| LCA CASE WAGE RATE UNIT | Year |
| PREVAILING WAGE | 96928 |
| PW UNIT OF PAY | Year |
| PW WAGE LEVEL | I |
| PW OES YEAR | 7/1/2020 - 6/30/2021 |
| TOTAL WORKSITE LOCATIONS | 1 |
| AGREE TO LC STATEMENT | True |
| H1B DEPENDENT | False |
| WILLFUL VIOLATOR | False |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | Baxley |
| PREPARER FIRST NAME | Shirley |
| PREPARER BUSINESS NAME | Shirley's Immigration Service |
| PREPARER EMAIL | shirley.baxley@sbcglobal.net |
