| LCA CASE NUMBER | I-200-22012-826068 |
| STATUS | Certified |
| LCA CASE SUBMIT | 2022-01-12 |
| DECISION DATE | 2022-01-20 |
| VISA CLASS | H-1B |
| LCA CASE JOB TITLE | Staff Modeling Engineer, Electrical Systems |
| SOC CODE | 17-2071.00 |
| SOC TITLE | Electrical Engineers |
| FULL TIME POSITION | True |
| LCA CASE EMPLOYMENT START DATE | 2022-01-24 |
| END DATE | 2025-01-23 |
| 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 | 02143 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 14123028414 |
| NAICS CODE | 33599 |
| EMPLOYER POC LAST NAME | Peterson |
| EMPLOYER POC FIRST NAME | Julia |
| EMPLOYER POC JOB TITLE | Talent Acquisition |
| EMPLOYER POC ADDRESS1 | 2810 Seventh St. |
| EMPLOYER POC CITY | Berkeley |
| EMPLOYER POC STATE | CA |
| EMPLOYER POC POSTAL CODE | 94710 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 18443676462 |
| EMPLOYER POC EMAIL | jpeterson@formenergy.com |
| AGENT REPRESENTING EMPLOYER | True |
| AGENT ATTORNEY LAST NAME | Hauer |
| AGENT ATTORNEY FIRST NAME | Douglas |
| AGENT ATTORNEY ADDRESS1 | One Financial Center |
| AGENT ATTORNEY ADDRESS2 | 41st Floor |
| AGENT ATTORNEY CITY | Boston |
| AGENT ATTORNEY STATE | MA |
| AGENT ATTORNEY POSTAL CODE | 02111 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PHONE | 16173483044 |
| AGENT ATTORNEY EMAIL ADDRESS | dhauer@mintz.com |
| LAWFIRM NAME BUSINESS NAME | Mintz |
| STATE OF HIGHEST COURT | MA |
| NAME OF HIGHEST STATE COURT | Supreme Judicial Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | False |
| WORKSITE ADDRESS1 | 2810 Seventh St. |
| LCA CASE WORKLOC1 CITY | Berkeley |
| WORKSITE COUNTY | ALAMEDA |
| LCA CASE WORKLOC1 STATE | CA |
| WORKSITE POSTAL CODE | 94710 |
| LCA CASE WAGE RATE FROM | 184000 |
| LCA CASE WAGE RATE UNIT | Year |
| PREVAILING WAGE | 143187 |
| PW UNIT OF PAY | Year |
| PW WAGE LEVEL | IV |
| PW OES YEAR | 7/1/2021 - 6/30/2022 |
| TOTAL WORKSITE LOCATIONS | 2 |
| 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 |
