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To be valid, the Employee's Notice of Rejection of Terms of the Arizona Workers' Compensation Law must be filled out in duplicate (i.e. The employer shall, in all cases, within five days of receipt of the notice, file a copy with the workers' compensation insurance carrier.They'll need to fill out Form 0114, Employee's Notice to Revoke Rejection of Terms of the Arizona Workers' Compensation Law, and file it with you. This form is for employees' whom have filed a rejection of the terms of Arizona workers' compensation law, and wish to revoke the rejection that they filed. Electronic filing of the Notice Terminating Prior Rejection of Coverage (Form 17A) is now available. Click here to begin completing the form. Please complete this form for injuries occurring after July 1, 2007. How does an LLC individual member reject coverage for workers' compensation? Print the Petition for Hearing form, then complete and mail it. Form nameVersion dateNotesAffidavit of Significant Financial Hardship (AS01)June 2018Legislative changesDisability Status Report (DS01)September 2012Employee's Claim Petition (EC04)June 2018Legislative changes