T FORM WSD-1.378 III Chapter 378, Employment Practices, Part III, Unlawful Suspension or Discharge Due to Work Injury Instructions Please completely fill out the WSD-1.378 III Complaint Form. You must file a complaint within 30 days of either: (1) the date of the alleged violation, (2) the date you learned of the alleged violation, or (3) the date you were released to return to work from a work injury. Please type or print legibly. Read all instructions before completing the forms. If you have.
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How to fill out the HI WSD-1.378III online
Filling out the HI WSD-1.378III complaint form can seem daunting at first. This guide offers step-by-step instructions to help you navigate the process easily and effectively, ensuring that you provide all necessary information accurately.
Follow the steps to successfully complete the HI WSD-1.378III form online.
- Click 'Get Form' button to obtain the form and open it in the editor.
- Begin by entering your personal details in items 1 through 6 and item 8. Include your full name, address, contact information, type of work performed, Social Security number, and employment status.
- In item 7, state whether you are currently employed or not. If no longer employed, provide the reason.
- Complete items 10 through 14 with information about your employer. This includes the business name, address, contact details, name and title of the owner, and the nature of the business.
- On the second page, provide a clear statement of the facts regarding your alleged violation. Include a brief explanation of the unlawful act and the date it occurred.
- Indicate what remedy you are seeking from the employer, such as back pay or reinstatement.
- Ensure you complete the verification and signature section. Your complaint must be signed in the presence of an authorized representative or a notary public.
- On the final page, fill in the details regarding the alleged unlawful act, along with information pertaining to your work injury.
- Before finalizing, review all entries you've made for accuracy and completeness.
- After reviewing, save changes, download, print, or share your completed form as needed.
Start compiling your documents and complete the HI WSD-1.378III form online today.
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