Certificate to employ a child age 14 or 15 during school months.

 

A form to be completed by the injured worker or by his or her attorney when making a claim for workers' compensation for injuries occurring prior to January 1, 2014.

 

A form to be completed by the injured worker or by his or her attorney when making a claim for workers' compensation for injuries occurring on or after January 1, 2014, based upon the revisions to the Workers’ Compensation Law made by Senate Bill 1.

 

A claim to be filed regarding a payment to the estate of air ambulance pilots, air ambulance registered professional nurses, emergency medical technicians, firefighters, law enforcement officers, and volunteer firefighters who were killed in the line of duty before August 28, 2017.

 

A claim to be filed regarding a payment to the estate of air ambulance pilots, air ambulance registered professional nurses, emergency medical technicians, firefighters, law enforcement officers, and volunteer firefighters who were killed in the line of duty between August 28, 2017 and before August 28, 2018. 

 

A claim to be filed regarding a payment to the estate of air ambulance pilots, air ambulance registered professional nurses, emergency medical technicians, firefighters, law enforcement officers, volunteer firefighters, air ambulance registered respiratory therapists, flight crew members, and public safety officers who were killed in the line of duty on or after August 28, 2018.

 

A form, when properly executed, that allows the Division to release or disclose certain information regarding an individual’s workers’ compensation records. 

 

An authorization for the release of claimant records.

 

This is the form for claimants to appeal an unemployment insurance determination.

 

An intake questionnaire regarding discrimination in employment to be completed within 180 days of alleged discrimination.