Employment History Form Spanish Formulario de Historial de Empleo
See also
| Document Information | ||
|---|---|---|
 Get help downloading & printing files.  How to complete a fillable form. |
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| Title |
 Employment History Form Spanish Formulario de Historial de Empleo (21 KB PDF)
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| Description | Used by injured worker to report their employment history for the past three years and the wages at each job. |
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| Detail | ||
| Form number | F242-109-999 | |
| Availability | Online only. See document above to download. |
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| Keywords | claim information, claims, industrial insurance, injury, work history, workers compensation, workers' compensation | |
| Languages | Spanish , English | |
| Valid dates | 01-2006 | |
| Contact information |
Claims for Job Injuries
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| Web pages | Workers' Comp Claims | |
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