Formulario de Historial de Empleo


Document Information
  Get help downloading & printing files.   How to complete a fillable form.
Title Formulario de Historial de Empleo
Description

Usado por el trabajador lesionado para reportar su historial de empleo y el salario de cada trabajo durante los últimos tres años

Document number F242-109-999
How to get this document
Keywords claim information, claims, industrial insurance, injury, work history, workers compensation, workers' compensation
Alt Language(s) English
Valid dates 01/2006
Contact information Claims for Job Injuries
Websites Workers' Comp Claims

End of main content, page footer follows.

Access Washington official state portal

© Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.