| LCA CASE NUMBER | I-200-24302-437328 |
| STATUS | Certified |
| LCA CASE SUBMIT | 2024-10-28 |
| DECISION DATE | 2024-11-04 |
| VISA CLASS | H-1B |
| LCA CASE JOB TITLE | Staff Global Supply Manager |
| SOC CODE | 11-3071.04 |
| SOC TITLE | Supply Chain Managers |
| FULL TIME POSITION | True |
| LCA CASE EMPLOYMENT START DATE | 2024-11-25 |
| END DATE | 2027-11-24 |
| 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 Street |
| EMPLOYER CITY | Somerville |
| EMPLOYER STATE | MA |
| EMPLOYER POSTAL CODE | 02143 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 15084313479 |
| EMPLOYER FEIN | 82-2266384 |
| NAICS CODE | 335999 |
| EMPLOYER POC LAST NAME | Urbanski |
| EMPLOYER POC FIRST NAME | Marlayna |
| EMPLOYER POC JOB TITLE | Senior People Systems Specialist |
| EMPLOYER POC ADDRESS1 | 30 Dane Street |
| EMPLOYER POC CITY | Somerville |
| EMPLOYER POC STATE | MA |
| EMPLOYER POC POSTAL CODE | 02143 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 15084313479 |
| EMPLOYER POC EMAIL | murbanski@formenergy.com |
| AGENT REPRESENTING EMPLOYER | True |
| AGENT ATTORNEY LAST NAME | Bahar |
| AGENT ATTORNEY FIRST NAME | Arash |
| AGENT ATTORNEY MIDDLE NAME | Ramineh |
| 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 | 14242594024 |
| AGENT ATTORNEY EMAIL ADDRESS | arbahar@mintz.com |
| LAWFIRM NAME BUSINESS NAME | Mintz |
| STATE OF HIGHEST COURT | CA |
| NAME OF HIGHEST STATE COURT | Supreme Court of CA |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | False |
| WORKSITE ADDRESS1 | 5805 Charlotte Drive |
| WORKSITE ADDRESS2 | Apt# A587 |
| LCA CASE WORKLOC1 CITY | San Jose |
| WORKSITE COUNTY | SANTA CLARA |
| LCA CASE WORKLOC1 STATE | CA |
| WORKSITE POSTAL CODE | 95123 |
| LCA CASE WAGE RATE FROM | 163000 |
| LCA CASE WAGE RATE UNIT | Year |
| PREVAILING WAGE | 132683 |
| PW UNIT OF PAY | Year |
| PW WAGE LEVEL | II |
| PW OES YEAR | 7/1/2024 - 6/30/2025 |
| TOTAL WORKSITE LOCATIONS | 3 |
| AGREE TO LC STATEMENT | True |
| H 1B DEPENDENT | False |
| WILLFUL VIOLATOR | False |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | Garcia |
| PREPARER FIRST NAME | Karolline |
| PREPARER MIDDLE INITIAL | B |
| PREPARER BUSINESS NAME | Mintz |
| PREPARER EMAIL | kbgarcia@mintz.com |