| LCA CASE NUMBER | I-200-21137-319770 |
| STATUS | Certified |
| LCA CASE SUBMIT | 2021-05-17 |
| DECISION DATE | 2021-05-24 |
| VISA CLASS | H-1B |
| LCA CASE JOB TITLE | Application Software Developer |
| SOC CODE | 15-1132.00 |
| SOC TITLE | Software Developers, Applications |
| 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 | FormAssembly, Inc. |
| EMPLOYER ADDRESS1 | 885 S. College Mall Road, #399 |
| EMPLOYER CITY | Bloomington |
| EMPLOYER STATE | IN |
| EMPLOYER POSTAL CODE | 47401 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 18442932367 |
| NAICS CODE | 541990 |
| EMPLOYER POC LAST NAME | Owens-Barham |
| EMPLOYER POC FIRST NAME | Joey |
| EMPLOYER POC JOB TITLE | Director of Talent and Culture |
| EMPLOYER POC ADDRESS 1 | 885 S. College Mall Road, #399 |
| EMPLOYER POC CITY | Bloomington |
| EMPLOYER POC STATE | IN |
| EMPLOYER POC POSTAL CODE | 47401 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 18442932367 |
| EMPLOYER POC EMAIL | joey@formassembly.com |
| AGENT REPRESENTING EMPLOYER | True |
| AGENT ATTORNEY LAST NAME | Baumgarten |
| AGENT ATTORNEY FIRST NAME | Kelly |
| AGENT ATTORNEY ADDRESS1 | 3731 Wilshire Blvd., Suite 810 |
| AGENT ATTORNEY CITY | Los Angeles |
| AGENT ATTORNEY STATE | CA |
| AGENT ATTORNEY POSTAL CODE | 90010 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | CALIFORNIA |
| AGENT ATTORNEY PHONE | 12133806280 |
| AGENT ATTORNEY EMAIL ADDRESS | baumgarten@dayzadlaw.com |
| LAWFIRM NAME BUSINESS NAME | Dayzad Law Offices, P.C. |
| STATE OF HIGHEST COURT | CA |
| NAME OF HIGHEST STATE COURT | Supreme |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | False |
| WORKSITE ADDRESS1 | 929 N. Marion St., #411 |
| LCA CASE WORKLOC1 CITY | Denver |
| WORKSITE COUNTY | DENVER |
| LCA CASE WORKLOC1 STATE | CO |
| WORKSITE POSTAL CODE | 80218 |
| LCA CASE WAGE RATE FROM | 92477 |
| LCA CASE WAGE RATE UNIT | Year |
| PREVAILING WAGE | 92477 |
| PW UNIT OF PAY | Year |
| PW WAGE LEVEL | II |
| 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 |
