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Get and Sign C240 Form 2011
Service during the 52 week period immediately preceding the date of accident? Yes No If "Yes", give date of discharge INSTRUCTIONS: 1. Give gross weekly earnings for the 52 weekly periods immediately preceding the date of accident. 2. If injured employee has not worked at the same work for a year or a substantial part thereof (234 days for a 5 day week, 270 days for a 6 day week) give the weekly gross earning of another employee of the same class who has worked for a year or a substantial...Show details
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