Method of Wage Payment (check one): Hourly Amount, Daily Amount, Weekly Salary Amount, Monthly Salary Amount, Yearly Salary Amount, Output of Employee Amount.
Employer provided: check the appropriate ones of Board, Rent, Housing, Lodging and Fuel.
Employee: check the appropriate ones of Work Overtime, Receive Gratuities and Paid Vacation/Holidays.
Service: unless this form has been submitted electronically, the original was mailed to the Commissioner and a copy to Counsel of record and the Administrative Law Judge.
Signature block: Name of Company, Signature, Title and Date.
| Question | Answer |
|---|---|
| Form Name | AWW-1 |
| Form Length | 4 pages |
| Fillable? | Yes |
| Fillable fields | 252 |
| Avg. time to fill out | 42 min |
| Edition | October 2016 Edition |
| Issuing agency | Kentucky Department of Workers' Claims |
| Other names | AWW-1, AWW1, Form AWW-1, Average Weekly Wage Certification |
| Official source | AWW-1 (Rev October 2016), Kentucky Department of Workers' Claims |
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