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Fillable Form HC-5 - Department of Labor and Industrial Relations

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STATE OF HAWAII DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS DISABILITY COMPENSATION DIVISION Princess Keelikolani Building, 830 Punchbowl Street, Room 209, Honolulu, Hawaii 96813 FORM HC-5 EMPLOYEE NOTIFICATION TO EMPLOYER FOR CALENDAR YEAR 2014 Instructions to employee: Keep a copy of your completed, signed form for yourself. Use this form if any of these apply to you: • You work for 2 or more employers** • You...
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