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All forms are in Acrobat PDF

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FWCJUA Operations Manual

FWCJUA Application Package  http  ftp (130 KB)Adobe PDF (updated 12/07)
ACORD 130 FL (2002/07)
ACORD 133 FL (2007/07)
Employment and Wage Information Release Agreement (2007/06)
Applicant’s Affidavit (2007/06)
Applicant's Affidavit As To Employee Leasing (2007/06)
ACORD 134 FL (2008/01) - Instructions
Supplemental Applications:
Employee Leasing/PEO Package  http  ftp (94 KB)Adobe PDF (updated 12/07)
FWCJUA Supplemental Employee Leasing Application
Acknowledgement by Labor Contractor and Client of Terms and Conditions of the
   Multiple Coordinated Policy
Acknowledgement by Client of the Terms and Conditions of Continued Coverage under
   the Multiple Coordinated Policy
Employee Leasing Consent To The Release Of Client Initiation Or Termination Information
Construction Industry Package  http  ftp (80 KB)Adobe PDF (updated 12/07)
Contractors Supplemental Application
"If Any" Acknowledgement Form


All Forms and Applications:

For help in completing these forms, click Here.

 
HTTPFTPTitle
HTTPFTPACORD 130FL (2002/07)
HTTPFTPACORD 133FL (2007/07)
HTTPFTPACORD 134FL (2008/01)
HTTPFTPERM-14
HTTPFTPEmployment & Wage Information Release Agreement
HTTPFTPApplicant’s Affidavit As To Employee Leasing (2007/06)
HTTPFTPApplicants Affidavit (2007/06)
HTTPFTPACORD 175FL (3/97)
HTTPFTPAcknowledgement by Labor Contractor MCP (2007/06)
HTTPFTPAcknowledgement by Client MCP (2007/06)
HTTPFTPEmployee Leasing Consent To The Release Of Client Initiation Or Termination Information (2007/06)
HTTPFTPSupplemental Employee Leasing Application
HTTPFTPEmployee Leasing / PEO Package
HTTPFTPContractors Supplemental Application (2007/06)
HTTPFTP'If Any' Acknowledgement Form (2007/06)
HTTPFTPEmployers Affidavit (2007/06)
HTTPFTPConstruction Package
HTTPFTPTruckers Supplemental Application
HTTPFTPHorse Trainer's Supplemental Application
HTTPFTP$2500 Deductible Application
HTTPFTPDrug Free Premium Credit Application
HTTPFTPSafety Program Premium Credit Application
HTTPFTPAgency Producer Agreement (2007/02)
HTTPFTPAgency Agreement Addendum to Exhibit A
HTTPFTPFWCJUA Application Package (2007/12)
HTTPFTPPayroll Service Application
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JUA Highlights
 PRODUCERS NOT PERMITTED TO NOTARIZE ANY FWCJUA APPLICATIONS AND/OR FORMS!
 
  Circular 08-06Market Assistance Program
 
 

Committing FRAUD is a crime!


 
   
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