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Case Number
I-200-18219-570712
1. Indicate the type of visa classification supported by this application (Write classification symbol):
H-1B
2. SOC (ONET/OES) code
29-1069
3. SOC (ONET/OES) occupation title
Physicians and Surgeons, All Other
4. Is this a full-time position?
Yes
Period of Intended Employment
5. Begin Date (mm/dd/yyyy)
11/5/2018 12:00:00 AM
6. End Date (mm/dd/yyyy)
11/5/2021 12:00:00 AM
7. Worker positions needed/basis for the visa classification supported by this application
Total Worker Positions Being Requested for Certification
1
1. Legal business name
Banner Medical Group
2. Trade name/Doing Business As (DBA), if applicable
3. Address 1
2901 N. Central Ave
10. Telephone number
602-747-4000
12. Federal Employer Identification Number (FEIN from IRS)
13. NAICS code (must be at least 4-digits)
622110
Important Note: The information contained in this Section must be that of an employee of the employer who is authorized to act on behalf of
the employer in labor certification matters. The information in this Section must be different from the agent or attorney information listed in
Section E, unless the attorney is an employee of the employer.
1. Contact's last (family) name
Yaqub
2. First (given) name
Yusuf
4. Contact's job title
Director, Hr Shared Services
5. Address 1
2901 N. Central Ave - Ste 160
12. Telephone number
602-747-7136
14. E-Mail address
Yusuf.yaqub@bannerhealth.com
1. Is the employer represented by an attorney or agent in the filing of this application? If "Yes", complete the remainder of Section E below.
2. Attorney or Agent's last (family) name
Martinez
3. First (given) name
Matthew
5. Address 1
1850 N Central Avenue Suite 1400
12. Telephone number
6022855056
14. E-Mail address
Mmartinez@dickinsonwright.com
15. Law firm/Business name
Dickinson Wright Pllc
16. Law firm/Business FEIN
17. State Bar number (only if attorney)
26722
18. State of highest court where attorney is in good standing (only if attorney)
Arizona
19. Name of the highest court where attorney is in good standing (only if attorney)
Arizona Supreme Court
1. Wage Rate (Required)
From: $
210,000.00
To: $
2. Per: (Choose only one)
Year
1. Address 1
14502 W. Meeker Blvd
5. State/District/Territory
Arizona
7. Agency which issued prevailing wage
7a. Prevailing wage tracking number (if applicable)
8. Wage level
II
9. Prevailing wage
$ 191,027.00
10. Per: (Choose only one)
11. Prevailing wage source (Choose only one)
OES
11a. Year source published
2018
11b. If "OES", and SWA/NPC did not issue prevailing wage OR "Other" in question 11, specify source
1. Is the employer H-1B dependent?
No
2. Is the employer a willful violator?No
3. If "Yes" is marked in questions I.1 and/or I.2, you must answer "Yes" or "No" regarding whether the
employer will use this application ONLY to support H-1B petitions or extensions of status for exempt H-1B
nonimmigrants?
If you marked "Yes" to questions I.1 and/or I.2 and "No" to question I.3, you MUST read Section I - Subsection 2 of the Labor
Condition Application - General Instructions Form ETA 9035CP under the heading "Additional Employer Labor Condition
Statements" and indicate your agreement to all three (3) additional statements summarized below.
- Displacement: Non-displacement of the U.S. workers in the employer's workforce
- Secondary Displacement: Non-displacement of U.S. workers in another employer's workforce; and
- Recruitment and Hiring: Recruitment of U.S. workers and hiring of U.S. workers applicant(s) who are equally or better qualified than the H-1B nonimmigrant(s).
4. I have read and agree to Additional Employer Labor Condition Statements A, B, and C above and as fully explained in Section I - Subsections 1 and 2 of the Labor Condition Application - General Instructions Form ETA 9035CP.
- Yes
- No
1. Last (family) name of hiring or designated official
Yaqub
2. First (given) name of hiring or designated official
Yusuf
4. Hiring or designated official title
Director, Hr Shared Services
1. Last (family) name
Martinez
2. First (given) name
Matthew
4. Firm/Business name
Dickinson Wright Pllc
5. E-Mail address
Mmartinez@dickinsonwright.com
By virtue of the signature below, the Department of Labor hereby acknowledges the following:
This certification is valid
From 11/5/2018 12:00:00 AM
To 11/5/2021 12:00:00 AM
Department of Labor, Office of Foreign Labor Certification
Determination Date (date signed)
8/7/2018 12:00:00 AM
Case Number
I-200-18219-570712
The Department of Labor is not the guarantor of the accuracy, truthfulness, or adequacy of a certified LCA.
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