Dwc Time Of Hire Pamplet Form PDF Details

One of the most important aspects of any business, whether it is small or large, is the recruitment and selection of new employees. A well-run organization takes the time to identify which candidates are a good fit for their company culture and vacant positions. The Dwc Time Of Hire Pamplet Form is a tool that can be used to help streamline this process. This form can be used to create a standardized process for recruiting new employees, evaluating their qualifications, and making hiring decisions. It also provides employers with information about employee benefits and compensation. Having this information readily available will help you make better hiring decisions and ensure that your new employees are a good fit for your company.

Form NameDwc Time Of Hire Pamplet Form
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namescalifornia dwc form 9783 1, notice personal, ca form acupuncturist, dwc form notice

Form Preview Example


If your employer or your employer's insurer does not have a Medical Provider Network, you may be able to change your treating physician to your personal chiropractor or acupuncturist following a work-related injury or illness. In order to be eligible to make this change, you must give your employer the name and business address of a personal chiropractor or acupuncturist in writing prior to the injury or illness. Your claims administrator generally has the right to select your treating physician within the first 30 days after your employer knows of your injury or illness. After your claims administrator has initiated your treatment with another doctor during this period, you may then, upon request, have your treatment transferred to your personal chiropractor or acupuncturist.

NOTE: If your date of injury is January 1, 2004 or later, a chiropractor cannot be your treating physician after you have received 24 chiropractic visits unless your employer has authorized additional visits in writing. The term “chiropractic visit” means any chiropractic office visit, regardless of whether the services performed involve chiropractic manipulation or are limited to evaluation and management. Once you have received 24 chiropractic visits, if you still require medical treatment, you will have to select a new physician who is not a chiropractor. This prohibition shall not apply to visits for postsurgical physical medicine visits prescribed by the surgeon, or physician designated by the surgeon, under the postsurgical component of the Division of Workers’ Compensation’s Medical Treatment Utilization Schedule.

You may use this form to notify your employer of your personal chiropractor or acupuncturist.

Your Chiropractor or Acupuncturist's Information:


(name of chiropractor or acupuncturist)


(street address, city, state, zip code)


(telephone number)


Employee Name (please print):


Employee's Address:


Employee's Signature ___________________________ Date: _________

Title 8, California Code of Regulations, section 9783.1. (Optional DWC Form 9783.1 Effective date July 1, 2014)

DWC FORM 9783.1 (7/2014)

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Filling in section 1 of dwc 9783 1 pamphlet

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