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Office of Talent 440 N. Broad Street, Suite 202 Philadelphia, PA 19130 Employee Benefits 440 N. Broad Street, Suite G10 Philadelphia, PA 19130 Telephone: 2154004630| Fax: 2154004631 benefits@philasd.orgWage

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How to fill out wage continuation enrollment form

01

Step 1: Obtain the wage continuation enrollment form from your HR department.

02

Step 2: Fill in your personal information including name, address, and employee ID.

03

Step 3: Indicate the reason for requesting wage continuation and the dates it will apply to.

04

Step 4: Sign and date the form, affirming that the information provided is accurate.

05

Step 5: Submit the completed form to your HR department for processing.

Who needs wage continuation enrollment form?

01

Employees who are unable to work due to illness or injury and are eligible for wage continuation benefits.

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What is wage continuation enrollment form?

The wage continuation enrollment form is a document that allows an employee to continue receiving their wage while on leave for a specific reason.

Who is required to file wage continuation enrollment form?

Any employee who is planning to take a leave of absence and wishes to continue receiving their wage during that time is required to file the wage continuation enrollment form.

How to fill out wage continuation enrollment form?

The wage continuation enrollment form must be filled out by the employee, indicating the reason for the leave of absence and providing any necessary documentation.

What is the purpose of wage continuation enrollment form?

The purpose of the wage continuation enrollment form is to ensure that employees can continue to receive their wage while on leave for a specific reason.

What information must be reported on wage continuation enrollment form?

The wage continuation enrollment form must include the employee's personal information, the reason for the leave of absence, the expected duration of the leave, and any supporting documentation.

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