| LCA CASE NUMBER | I-200-22090-025495 |
| STATUS | Certified |
| LCA CASE SUBMIT | 2022-03-31 |
| DECISION DATE | 2022-04-07 |
| VISA CLASS | H-1B |
| LCA CASE JOB TITLE | Interior Designer |
| SOC CODE | 27-1025.00 |
| SOC TITLE | Interior Designers |
| FULL TIME POSITION | True |
| LCA CASE EMPLOYMENT START DATE | 2022-09-30 |
| END DATE | 2025-09-29 |
| 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 | Formbuilder Development, LLC |
| EMPLOYER ADDRESS1 | 1984 Crosswaters Drive |
| EMPLOYER CITY | Dacula |
| EMPLOYER STATE | GA |
| EMPLOYER POSTAL CODE | 30019 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 16787073590 |
| NAICS CODE | 54131 |
| EMPLOYER POC LAST NAME | Sawyer |
| EMPLOYER POC FIRST NAME | Akinsola |
| EMPLOYER POC JOB TITLE | Managing Partner |
| EMPLOYER POC ADDRESS1 | 1984 Crosswaters Drive |
| EMPLOYER POC CITY | Dacula |
| EMPLOYER POC STATE | GA |
| EMPLOYER POC POSTAL CODE | 30019 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 16787073590 |
| EMPLOYER POC EMAIL | sawyerra@ymail.com |
| AGENT REPRESENTING EMPLOYER | True |
| AGENT ATTORNEY LAST NAME | Chea |
| AGENT ATTORNEY FIRST NAME | Socheat |
| AGENT ATTORNEY ADDRESS1 | 3500 Duluth Park Lane, Suite 300 |
| AGENT ATTORNEY CITY | Duluth |
| AGENT ATTORNEY STATE | GA |
| AGENT ATTORNEY POSTAL CODE | 30096 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PHONE | 17706238880 |
| AGENT ATTORNEY EMAIL ADDRESS | socheat@socheatchea.com |
| LAWFIRM NAME BUSINESS NAME | Socheat Chea, PC |
| STATE OF HIGHEST COURT | GA |
| NAME OF HIGHEST STATE COURT | Georgia Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | False |
| WORKSITE ADDRESS1 | 1984 Crosswaters Drive |
| LCA CASE WORKLOC1 CITY | Dacula |
| WORKSITE COUNTY | GWINNETT |
| LCA CASE WORKLOC1 STATE | GA |
| WORKSITE POSTAL CODE | 30019 |
| LCA CASE WAGE RATE FROM | 41999 |
| LCA CASE WAGE RATE TO | 42000 |
| LCA CASE WAGE RATE UNIT | Year |
| PREVAILING WAGE | 41454 |
| PW UNIT OF PAY | Year |
| PW WAGE LEVEL | I |
| PW OES YEAR | 7/1/2021 - 6/30/2022 |
| TOTAL WORKSITE LOCATIONS | 1 |
| AGREE TO LC STATEMENT | True |
| H1B DEPENDENT | False |
| WILLFUL VIOLATOR | False |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | Chea |
| PREPARER FIRST NAME | Socheat |
| PREPARER BUSINESS NAME | Socheat Chea, PC |
| PREPARER EMAIL | socheat@socheatchea.com |