Historial de Empleo
 

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Title Historial de Empleo (21 KB PDF)
Description Used by injured worker to report their employment history for the past three years and the wages at each job.
Detail
Form number F242-109-999
Availability Online only
Keywords claim information, claims, employment history, industrial insurance, injured worker, injury, insurance, wages, work history, workers compensation, workers' compensation
Languages Spanish , English
Valid dates 01-2006
Contact information Claims for Job Injuries
Web pages Workers' Comp Claims

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