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Get and Sign Dwc Form Ru 91 1995-2022

Get and Sign Dwc Form Ru 91 1995-2022

Use a california ru 91 1995 template to make your document workflow more streamlined.

Form, the employee may contact the Information and Assistance Officer at the Division of Workers' Compensation. The phone number can be found in the State Government section of the phone book. EMPLOYEE NAME: (LAST) EMPLOYER NAME: (FIRST) (M.I.) CLAIM#: JOB ADDRESS: HRS. WORKED PER DAY: JOB TITLE: HRS. WORKED PER WEEK: DESCRIPTION OF JOB RESPONSIBILITIES: (DESCRIBE ALL JOB DUTIES) 1. Check the frequency of activity required of the employee to perform the job. ACTIVITY (Hours per...
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