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Certification of Health Care Provider for Employees Serious Health Condition ___OMB Control Number: 12150181 Expires: 12/31/2011SECTION I: For Completion by the EMPLOYER INSTRUCTIONS to the EMPLOYER:

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Obtain the necessary forms from the US Department of Labor website or office.

02

Fill out personal information accurately including name, address, social security number, etc.

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Provide information about previous employment history such as job titles, dates of employment, and reasons for leaving.

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Review the completed form for any errors or missing information before submitting.

Who needs us department of labor?

01

Employees who are seeking benefits such as unemployment insurance, workers' compensation, or family and medical leave.

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Employers who are required to report wage and hour information or maintain records for compliance purposes.

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What is us department of labor?

The U.S. Department of Labor is a federal agency responsible for promoting and protecting the rights of American workers.

Who is required to file us department of labor?

Employers are required to file certain reports and forms with the U.S. Department of Labor.

How to fill out us department of labor?

Employers can fill out the required forms and reports online through the Department of Labor's website or by submitting paper forms via mail.

What is the purpose of us department of labor?

The U.S. Department of Labor aims to ensure safe working conditions, fair wages, and benefits for American workers.

What information must be reported on us department of labor?

Employers must report information related to wages, hours worked, workplace injuries, and other labor-related data.

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