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Vermont Department of LaborEMPLOYEE DECLARATION OF HEALTH CARE This form must be completed annually by employees who are not enrolled in a Health Care plan offered by their employer, which provides
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How to fill out employee declaration of health
How to fill out employee declaration of health
01
Obtain a copy of the employee declaration of health form.
02
Read and understand the instructions provided on the form.
03
Fill in your personal details such as your name, address, and contact information.
04
Answer the questions on the form accurately and truthfully.
05
Provide information about any pre-existing medical conditions or medications you are currently taking, if applicable.
06
Sign and date the form to certify that the information provided is true and accurate.
07
Submit the completed form to the appropriate authority as instructed, such as your employer or human resources department.
Who needs employee declaration of health?
01
Any employee who is required by their employer or the relevant authorities to provide a declaration of their health status.
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