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Self-Restriction to Part-Time Work

Document Number:  WKC-12698

Description:  This form should be filed by an injured worker who limited themselves to part-time work.  This form is for an injured worker to advise Worker's Compensation whether or not they were self employed or worked for someone else.

Comments:  This form should be printed and completed by hand.

Content Contact:  Don Martin

Document Attachment:  WKC-12698 (pdf/9 KB)

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