| LCA CASE NUMBER | I-200-21174-422501 |
| STATUS | Certified |
| LCA CASE SUBMIT | 2021-06-23 |
| DECISION DATE | 2021-06-30 |
| VISA CLASS | H-1B |
| LCA CASE JOB TITLE | Battery Engineer II |
| SOC CODE | 19-2031.00 |
| SOC TITLE | Chemists |
| FULL TIME POSITION | True |
| LCA CASE EMPLOYMENT START DATE | 2021-07-26 |
| END DATE | 2024-07-25 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 1 |
| AMENDED PETITION | 0 |
| LCA CASE EMPLOYER NAME | Form Energy, Inc. |
| EMPLOYER ADDRESS1 | 30 Dane St. |
| EMPLOYER CITY | Somerville |
| EMPLOYER STATE | MA |
| EMPLOYER POSTAL CODE | 2143 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 14123028414 |
| NAICS CODE | 33599 |
| EMPLOYER POC LAST NAME | Crosby |
| EMPLOYER POC FIRST NAME | Maggie |
| EMPLOYER POC JOB TITLE | Senior Manager, People Operations |
| EMPLOYER POC ADDRESS 1 | 30 Dane St. |
| EMPLOYER POC CITY | Somerville |
| EMPLOYER POC STATE | MA |
| EMPLOYER POC POSTAL CODE | 02143 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 19529942093 |
| EMPLOYER POC EMAIL | mcrosby@formenergy.com |
| AGENT REPRESENTING EMPLOYER | True |
| AGENT ATTORNEY LAST NAME | Steinberg |
| AGENT ATTORNEY FIRST NAME | Lindsey |
| AGENT ATTORNEY MIDDLE NAME | H |
| AGENT ATTORNEY ADDRESS1 | One Financial Center |
| AGENT ATTORNEY ADDRESS2 | 41st Floor |
| AGENT ATTORNEY CITY | Boston |
| AGENT ATTORNEY STATE | MA |
| AGENT ATTORNEY POSTAL CODE | 2210 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PHONE | 16173481804 |
| AGENT ATTORNEY EMAIL ADDRESS | LHSteinberg@mintz.com |
| LAWFIRM NAME BUSINESS NAME | Mintz |
| STATE OF HIGHEST COURT | DC |
| NAME OF HIGHEST STATE COURT | Court of Appeals |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | False |
| WORKSITE ADDRESS1 | 30 Dane St. |
| LCA CASE WORKLOC1 CITY | Somerville |
| WORKSITE COUNTY | SOMERVILLE CITY |
| LCA CASE WORKLOC1 STATE | MA |
| WORKSITE POSTAL CODE | 2143 |
| LCA CASE WAGE RATE FROM | 110000 |
| LCA CASE WAGE RATE UNIT | Year |
| PREVAILING WAGE | 75504 |
| 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 |
| PREPARER LAST NAME | DiNicola |
| PREPARER FIRST NAME | Colleen |
| PREPARER MIDDLE INITIAL | M |
| PREPARER BUSINESS NAME | Mintz |
| PREPARER EMAIL | cmdinicola@mintz.com |
