California Department of Industrial Relations Forms

60
total templates

Documents

60

DLSE WCA Form 1 "Initial Report or Claim" - California (Chinese)

Rate (4.4 / 5) 55 votes
Size: 1 MB
3 pages

DLSE WCA Form 1 "Initial Report or Claim" - California

Rate (4.9 / 5) 7 votes
Size: 493 KB
3 pages

DLSE WCA Form 1 "Initial Report or Claim" - California (Korean)

Rate (4.4 / 5) 15 votes
Size: 1 MB
3 pages

Form EPA-1 "Equal Pay Act Complaint" - California

Rate (4.6 / 5) 32 votes
Size: 258 KB
3 pages

Form A-5 "Corporate Resolution Authorizing Application to the Director of Industrial Relations, State of California for a Certificate of Consent to Self-insure Workers' Compensation Liabilities" - California

Rate (4.5 / 5) 39 votes
Size: 1 MB
1 page

Form A-6 "Agreement and Undertaking for Security Deposit" - California

Rate (4.6 / 5) 53 votes
Size: 266 KB
1 page

Form A-4 "Guaranty of Workers' Compensation Liabilities" - California

Rate (4.7 / 5) 41 votes
Size: 332 KB
4 pages

Form S-3 "Corporate Resolution Authorizing Application to the Director of Industrial Relations, State of California for a Certificate of Consent to Self-insure Workers' Compensation Liabilities" - California

Rate (4.8 / 5) 71 votes
Size: 508 KB
1 page

Form S-6 "Agreement and Undertaking for Security Deposit" - California

Rate (4.3 / 5) 42 votes
Size: 1 MB
1 page

Form A-1 "Application for Certificate of Consent to Self-insure as a Private Employer Self-insurer" - California

Rate (4.5 / 5) 46 votes
Size: 1 MB
6 pages

Form A-2 "Application for Certificate of Consent to Self-insure as a Public Agency Employer Self-insurer" - California

Rate (4.8 / 5) 68 votes
Size: 3 MB
5 pages

Form S-1 "Group Master Application for Certificate of Consent to Self-insure as a Group Self-insurer" - California

Rate (4.4 / 5) 50 votes
Size: 1 MB
6 pages

Form S-4 "Indemnity Agreement and Power of Attorney" - California

Rate (4.3 / 5) 68 votes
Size: 1 MB
2 pages

Form S-5 "Agreement of Assumption and Guarantee of Workers' Compensation Liabilities for Group and Affiliate Members" - California

Rate (4.6 / 5) 46 votes
Size: 1 MB
2 pages

Form RCI1 "Retaliation Complaint" - California

Rate (4.8 / 5) 46 votes
Size: 1 MB
8 pages

Formulario RCI1 "Queja Sobre Represalias" - California (Spanish)

Rate (4.3 / 5) 64 votes
Size: 1 MB
9 pages

Formulario DLSE-PW1 "Reclamo De Trabajadores De Obras Publicas" - California (Spanish)

Rate (4.7 / 5) 47 votes
Size: 211 KB
2 pages

Form DLSE-PW1 "Public Works - Worker Complaint" - California

Rate (4.5 / 5) 29 votes
Size: 350 KB
2 pages

DLSE Form 1 "Initial Report or Claim" - California (Tagalog)

Rate (4.5 / 5) 31 votes
Size: 1 MB
4 pages

DLSE Form 1 "Initial Report or Claim" - California

Rate (4.5 / 5) 32 votes
Size: 437 KB
4 pages

Form DLSE8 "Payday Notice" - California

Rate (4.6 / 5) 20 votes
Size: 54 KB
1 page

Form P-1 "Self-insurer's Profile and Financial Summary Report" - California

Rate (4.3 / 5) 19 votes
Size: 411 KB
10 pages

Form J-1 "Joint Powers Authority (Jpa) Self-insurer's Profile and Financial Summary Report" - California

Rate (4.4 / 5) 26 votes
Size: 423 KB
10 pages

Form A-3A "Private / Public Interim Application" - California

Rate (4.3 / 5) 56 votes
Size: 1 MB
1 page

Form A-3B "Application for Permanent Certificate of Consent to Self-insure for Interim Self-insurer" - California

Rate (4.4 / 5) 54 votes
Size: 1 MB
2 pages

Form S-2B "Application for Affiliate Certificate of Consent to Self-insure as a Member of a Group Self-insurer" - California

Rate (4.4 / 5) 70 votes
Size: 1 MB
2 pages

Form S-2A "Group Affiliate Member Interim Application" - California

Rate (4.3 / 5) 44 votes
Size: 1 MB
1 page

WCAB Form 24 "Pre-trial Conference Statement" - California

Rate (4.6 / 5) 30 votes
Size: 4 MB
5 pages

Form 33 "Safety and Health Program Assessment Worksheet" - California

Rate (4.4 / 5) 80 votes
Size: 52 KB
11 pages

DWC/WCAB Form 37 "Notice of Dismissal of Attorney" - California

Rate (4.3 / 5) 25 votes
Size: 122 KB
1 page

Form DWC-AU-906 "Audit Complaint Form" - California

Rate (4.6 / 5) 44 votes
Size: 87 KB
1 page

Form 105 "Request for Qualified Medical Evaluator Panel" - California

Rate (4.6 / 5) 61 votes
Size: 2 MB
3 pages

Form 110 "Qme Appointment Notification Form" - California

Rate (4.8 / 5) 35 votes
Size: 1 MB
2 pages

DWC-AD Form 100 "Employee's Disability Questionnaire" - California

Rate (4.8 / 5) 26 votes
Size: 1 MB
2 pages

Cal/OSHA Form 300 Appendix A "Log of Work-Related Injuries and Illnesses" - California

Rate (4.3 / 5) 12 votes
Size: 499 KB
1 page

DWC Form 280 "Petition for Change of Primary Treating Physician" - California

Rate (4.3 / 5) 19 votes
Size: 167 KB
4 pages

Form DIA510 "Notice of Employee Death" - California

Rate (4.4 / 5) 71 votes
Size: 140 KB
1 page

Instructions for QME Form 105 "Request for Qualified Medical Evaluator Panel (Unrepresented Employee)" - California

Rate (4.5 / 5) 18 votes
Size: 268 KB
2 pages

Instructions for QME Form 106 "Request for Qme Panel Under Labor Code 4062.2 Represented - for Injuries Occurring Prior to January 1, 2005" - California

Rate (4.4 / 5) 17 votes
Size: 286 KB
2 pages

Form 5021 "Doctors First Report of Occupational Injury or Illness" - California

Rate (4.8 / 5) 75 votes
Size: 114 KB
3 pages
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