Fiscal Year

2022

Case Number

A-21130-84326

Case Status

Certified-Expired

Received Date

2021-06-18

Decision Date

2021-11-12

Refile

N

Original File Date

2022-01-01 10:25:17

Previous SWA Case Number State

Schedule A Sheepherder

N

Employer Name

Peninsula Community Health Services

Employer Name Slug

peninsula-community-health-services

Employer Address 1

400 Warren Avenue, Suite 200

Employer Address 2

PO Box 960

Employer City

Bremerton

Employer City Slug

bremerton

Employer State

WASHINGTON

Employer State Slug

washington

Employer Country

UNITED STATES OF AMERICA

Employer Postal Code

98337

Employer Phone

360-475-6700

Employer Number of Employees

280

Employer Year Commenced Business

1989

NAICS Code

621111

FW Ownership Interest

N

Employer Contact Name

Kirsten E Jennings

Employer Contact Address 1

400 Warren Avenue, Suite 200

Employer Contact Address 2

PO Box 960

Employer Contact City

Bremerton

Employer Contact State/Province

WASHINGTON

Employer Contact Country

UNITED STATES OF AMERICA

Employer Contact Postal Code

98337

Employer Contact Phone

360-475-3098

Employer Contact Email

kjennings@pchsweb.org

Agent Attorney Name

Dayna Kelly

Agent Attorney Firm Name

Law Offices of Dayna Kelly, P.C.

Agent Attorney Phone

(919) 969-7200

Agent Attorney Address 1

250 E Winmore Avenue

Agent Attorney Address 2

Agent Attorney City

Chapel Hill

Agent Attorney State/Province

NORTH CAROLINA

Agent Attorney Country

UNITED STATES OF AMERICA

Agent Attorney Postal Code

27516

Agent Attorney Email

info@dkelly.com

PW Track Number

P10020203727521

PW SOC Code

29-1062

PW SOC Title

Family and General Practitioners

PW Skill Level

N/A

PW Wage

208000.00

PW Unit of Pay

Year

PW Wage Source

OES

PW Determination Date

2020-12-22

PW Expiration Date

2021-06-30

Wage Offer From

208000.00

Wage Offer To

217800.00

Average Salary

212900.00

Wage Unit of Pay

Year

Worksite Address 1

320 S Kitsap Blvd

Worksite Address 2

Worksite City

Port Orchard

Worksite City Slug

port-orchard

Worksite State

WASHINGTON

Worksite Postal Code

98366

Job Title

Family Practice Physician

Job Title Slug

family-practice-physician

Minimum Education

Other

Major Field of Study

Medicine

Required Training

Y

Required Experience

N

Required Experience Months

Accept Alternative Field of Study

N

Accept Alternative Major Field of Study

Accept Alternative Combination

N

Accept Alternative Combination Education

Accept Alternative Combination Education Years

Accept Foreign Education

Y

Accept Alternative Occupation

N

Accept Alternative Occupation Months

Accept Alternative Job Title

Job Opportunity Requirements Normal

Y

Foreign Language Required

N

Specific Skills

Medical Degree or foreign equivalent. Complete Family Medicine residency training program. Board certified BC or board certified BE in family medicine. Physician is board eligible upon completion of family medicine residency training. Prior to commencement of employment, must have Drug Enforcement Administration Controlled Substance Registration Certificate DEA, CPR certification, drivers license and auto insurance, and, Washington State Department of Health Physician and Surgeon license.

Combination Occupation

N

Offered to Applicant Foreign Worker

Y

Foreign Worker Live on Premises

N

Foreign Worker Live in Domestic Service

N

Foreign Worker Live in Domestic Service Count

Professional Occupation

Y

Application for College/University Teacher

N

SWA Job Order Start Date

2021-03-15

SWA Job Order End Date

2021-04-19

Sunday Edition Newspaper

Y

First Newspaper Name

Kitsap Sun

First Advertisement Start Date

2021-03-21

Second Newspaper Ad Name

Kitsap Sun

Second Advertisement Type

Newspaper

Second Ad Start Date

2021-03-28

Employer Website From Date

2021-04-22

Employer Website To Date

2021-05-07

Professional Organization Ad From Date

2022-01-01 10:25:17

Professional Organization Advertisement To Date

2022-01-01 10:25:17

Job Search Website From Date

2021-03-24

Job Search Website To Date

2021-04-22

Employee Referral Program From Date

2021-04-22

Employee Referral Program To Date

2021-05-03

Local Ethnic Paper From Date

2022-01-01 10:25:17

Local Ethnic Paper To Date

2022-01-01 10:25:17

Radio/TV Ad From Date

2022-01-01 10:25:17

Radio/TV Ad To Date

2022-01-01 10:25:17

Employer Received Payment

N

Posted Notice at Worksite

Y

Layoff in Past Six Months

N

Country of Citizenship

CANADA

Foreign Worker Birth Country

CANADA

Class of Admission

H-1B

Foreign Worker Education

Other

Foreign Worker Information: Major

MEDICINE

Foreign Worker Years of Education Completed

2014

Foreign Worker Institution of Education

ROSS UNIVERSITY SCHOOL OF MEDICINE

Foreign Worker Education Institution Address 1

PO BOX 266 ROSEAU

Foreign Worker Education Institution Address 2

Foreign Worker Education Institution City

PORTSMOUTH

Foreign Worker Education Institution State/Province

Foreign Worker Education Institution Country

DOMINICA

Foreign Worker Education Institution Postal Code

Foreign Worker Experience with Employer

N/A

Foreign Worker Employer Pays for Education

N

Foreign Worker Currently Employed

Y

Employer Completed Application

N

Preparer Name

Dayna Kelly

Preparer Title

Attorney

Preparer Email

info@dkelly.com

Employer Information Declaration Name

Jennifer KreidlerMoss

Employer Information Declaration Title

CEO