Get the free Supplemental Job Displacement Voucher Form - Geklaw

SUPPLEMENTAL JOB DISPLACEMENT NONTRANSFERABLE VOUCHER FORM FOR INJURIES OCCURRING ON OR AFTER 1/1/13 DWC AD 10133.32 This is a supplemental job displacement nontransferable $6,000 voucher for education

How to fill out supplemental job displacement voucher

How to fill out supplemental job displacement voucher

1. To fill out the supplemental job displacement voucher, follow these steps:
2. Obtain a supplemental job displacement voucher form from your employer or the California Division of Workers' Compensation website.
3. Fill in the necessary personal information, including your name, address, and contact details.
4. Provide details about your employment history, including the dates of your previous employment and the reasons for job displacement.
5. Attach any supporting documentation, such as termination letters, layoff notices, or other proof of job displacement.
6. Review the completed form for accuracy and make any necessary corrections.
7. Sign and date the voucher.
8. Submit the completed voucher to your employer or the appropriate workers' compensation authority for processing.
9. It is recommended to keep a copy of the filled-out voucher for your records.

Who needs supplemental job displacement voucher?

1. Supplemental job displacement vouchers are typically needed by workers who have been permanently displaced from their employment due to a work-related injury or illness. This voucher provides assistance to eligible workers for retraining, skill enhancement, job placement, and related services. Eligibility criteria may vary by jurisdiction, so it is important to consult with your employer or the relevant workers' compensation authority to determine if you qualify for a supplemental job displacement voucher.

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What is supplemental job displacement voucher?

A supplemental job displacement voucher is a financial benefit provided to an injured worker in California, allowing them to use the funds for education or training to help them find new employment after a work-related injury.

Who is required to file supplemental job displacement voucher?

Employers are required to provide a supplemental job displacement voucher to an injured employee if the employee has not been offered a job within 60 days of their injury claim being determined as permanent and stationary.

How to fill out supplemental job displacement voucher?

To fill out the supplemental job displacement voucher, the injured worker should complete the provided form by entering personal information, details about the injury, and the amount of the voucher. It is important to follow the instructions included with the voucher.

What is the purpose of supplemental job displacement voucher?

The purpose of the supplemental job displacement voucher is to provide injured workers with financial assistance for education, training, or job placement services to facilitate their return to the workforce.

What information must be reported on supplemental job displacement voucher?

The supplemental job displacement voucher must include the injured worker's name, address, claim number, the date of injury, and the amount of the voucher along with any intended use for the funds.