Get La Form 1669 C 2016-2025

Filling out the LA Form 1669 C online is a straightforward process that allows individuals with sufficient experience in workers' compensation claims to request a waiver from the examination. This guide provides detailed, step-by-step instructions to help you complete the form accurately.

Follow the steps to successfully fill out the LA Form 1669 C online.

1. Click the ‘Get Form’ button to access the LA Form 1669 C and open it in your preferred editing tool.
2. Begin by entering your name in the 'Applicant Name' field. Ensure that this matches your legal name as it will appear on your license.
3. In Part 1, provide your employment experience. Fill in the 'Employer Name,' 'City,' and 'Supervisor’s Name' for each of your past employers. Include a brief description of your job duties for transparency.
4. Fill in the 'From' and 'To' dates for each employment period, ensuring accuracy, as these dates will establish your qualifying experience.
5. If you have more employment history than can fit in the provided sections, list any additional employers on a separate sheet, if necessary.
6. In Part 2, identify all states where you currently hold or held an adjuster license. This information is crucial for your application.
7. Complete Part 3 by listing any relevant education or industry designations you hold that may support your application for a waiver.
8. Review the declaration statement carefully. You must certify the information provided is true and correct before signing the document.
9. Sign and date the form in the designated areas. Additionally, include your Social Security Number as required for your application.
10. Once completed, save your changes. You can then download, print, or share the form as necessary. Ensure that you submit it before the application deadline.

Complete your documents online today and ensure all your information is submitted accurately.