Wage Loss Statement For Job Search {BWC-1268}

BWC-1268 - WAGE LOSS STATEMENT FOR JOB SEARCH. Use this form when requesting wage loss compensation. BWC requires you to report all earnings, including checks, cash or other remuneration from any type of work activity or employment, including full-time, part-time, self-employment or commission work. You must provide all information requested for each job contact. Failure to complete the form in full could result in reductions in the benefit payable. Attach verification of Internet contacts to this form, e.g., e-mail confirmations, electronic receipts. Complete this form weekly. You should use more than one form for each week. Submit or mail your forms to your local customer service specialist at least every four weeks. Job searches may be subject to verification by BWC. If your employer is self-insured, mail your completed form(s) to your self-insuring employer. www.FormsWorkflow.com