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Get DWC AD Form 1013333 Description Of Employees Job Duties Draft 2doc - Dir Ca

The employer and employee and is intended to describe the employee's job duties. The completed form will be reviewed to determine whether the employee is able to return to work. EMPLOYEE NAME: (LAST) EMPLOYER NAME: (FIRST) (M.I.) CLAIM#: JOB ADDRESS: JOB TITLE: HRS. WORKED PER DAY: HRS. WORKED PER WEEK: DESCRIPTION OF JOB RESPONSIBILITIES: (DESCRIBE ALL JOB DUTIES) Please check one: Regular Duty Modified Duty Alternative Work 1. Check the frequency of activity required of.

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