Earned Paid Sick Time Claim Form
THE INDUSTRIAL COMMISSION OF ARIZONA
LABOR DEPARTMENT
Earned Paid Sick Time Claim Form
* indicates required field

CLAIMANT INFORMATION:
Note: You must promptly notify the Labor Department of any changes to your contact information.

EMPLOYER INFORMATION:

EMPLOYMENT INFORMATION:

COMPLAINT INFORMATION:

Earned Paid Sick Time Claim Form

 

Sign and Date Section
12/4/2020 ]





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