Workers Compensation Exemption Form

Workers Compensation Exemption Form
Company Name
Jetlock Corp
Federal Employer ID
1231279878291
Business Address
54 Benson Park Drive
Neverstink, New York, 12765
State where Incorporated
New York
Phone Number
(405) 395-3405

Organization Information

Date of Incorporation
03/16/2016
Entity Type
Partnership
Employee Count
23
Total Number of Partners Electing Coverage
2
Number of Partners
2
Description of business operation and work process including the type of work performed by workers
Aircraft cleaning and detailing services.
Exemption qualification of organization:
Casual employees with irregular schedules.
Item - signature 0
Representative
Mark A. Coon
Date
03/27/2020
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About this template
A workers compensation exemption form is a document used for exemption application by a company or organization for providing workers compensation. This means that employers will not shoulder the employee's work-related injuries and illnesses. State governments usually require companies or organizations to shoulder these, however to such exceptions, companies or organizations are allowed to be exempt.

This workers compensation exemption form PDF template serves a quick form tool that can help produce the document in minutes. Whether you are an organization processing the application or the applicant that would like to get a certification, this template can be yours for free. Just copy this template to your Jotform account, modify it to your preference, and start receiving form submissions for processing applications.

Categories
Details
2,591 Clone
Created by
EdwardWrighton
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