FORMS
This page provides our downloadable departmental forms.
If you do not see a form or need more information, Contact Us.
Please Note: Job orders are now easy and simple to submit ONLINE.
Post your job orders by logging in and using our VIeWS system.
If you are having trouble, one of our Business Representatives can assist you.
Authorization to Release Medical Records
Used to disclose all medical records or other information regarding my treatment, hospitalization and/or outpatient.
Claim for Compensation on Account of Death
Used to claim compensation in the event of death.
Employee’s Claim for Compensation for Disability
Used by employees to claim compensation for disability.
Conditions Governing Death Benefits
Claim for compensation on account of death form should be completed and forwarded to this Office accompanied by the following documents.
Memorandum
Employer’s Insurance Certificate
Employer’s First Report and Employee’s Notice of Injury or Occupational Illness
Used to provides information on the claimant, employer, insurance carrier and medical practitioner necessary to begin the claims process.
Standard Form for Surgeon’s Report
Surgeon’s Report.
Estimate Employer’s Report
Used by Employers to estimate their premium for Workers’ Compensation Insurance
Actual Employer’s Report
Used by Employers to determine their premium for Workers’ Compensation Insurance
Workers’ Compensation Trust Fund Handbook
Learn More about “The Workers Compensation Trust Fund” as it pertains to insurance protection for working men and women throughout the Virgin Islands in the event of work-related accidents, under which they are entitled to medical rehabilitation, along with restoration of a portion of wages lost as a result of disability and vocational rehabilitation where necessary.
Credit/Debit Card Payment Authorization Form
Used by employers to submit payment via Credit/Debit Card
Unemployment Insurance Business Status Change
Used to notify Unemployment Insurance of changes in legal form, closing of operations, transfers, or locale of operations.
New Hire Reporting
Used by employers to report hiring of new personnel.
Employer Wage and Contribution Report
Used to file unemployment insurance quarterly wage and hour contributions.
Unemployment Insurance Employer Registration
Employer Registration for Unemployment Insurance
Multiple Worksite Report Form
The Multiple Worksite Report (MWR) form is used to collect employment and wages by individual work location in the Virgin Islands.
Youth Service Application
This form is used for proposals for Youth Workforce Development Services authorized through the Workforce Innovation and Opportunity Act of 2014 (WIOA).
Virgin Islands Division of Occupational Safety & Health Consultation Request
VI Division of Occupational Safety and Health (VIDOSH) On-Site Consultation Program offers no-cost and confidential occupational safety and health services to public sector U.S. Virgin Islands Government Departments and Agencies.
Employer Unemployment Insurance Appeal
This form is used by employers to appeal UI determination.
Unemployment Insurance Employer Account Update
This form provides the UI Tax Unit with accurate and current details about your business.
Interstate Assistance Package
Used by individuals no longer residing in the territory to file for Unemployment Insurance
Wrongful Discharge Form
Complete this application if you believe that you were wrongfully discharged from your job.
Wage Claim
Used to file the claim when there is an alleged violation of wage and hour laws
Employment Discrimination
Used by the employee to file the claim of employment discrimination in the workplace.
Claimant Unemployment Insurance Appeal
This form is used by claimants to appeal UI determination.
OSHA Complaint Form
Used by any employees or representatives of employees who believe that a violation of a safety or health standard exists that threatens physical harm, or that an imminent danger exists.
2024 Summer Youth Work Experience Program
Application for those seeking summer work experience.
We’re sorry, the application period has now ended. We look forward to serving you in 2025!
2024 LIFT Program Application
Labor Investing For Tomorrow application.
We’re sorry, the application period has now ended. We look forward to serving you in 2025!
2024 Career Exploration
A 4-week Career Exploration program targeting youths 14-15-years-old.
We’re sorry, the application period has now ended. We look forward to serving you in 2025!
Summer Work Experience Participant Handbook
Customer manual for those participating in the Summer Youth Work Experience Program
Summer Work Experience Supervisor’s Handbook
Supervisor manual for those participating in the Summer Youth Work Experience Program
Summer Employment Employer Request Form
Providers, please use this form to request students for the Summer Work Experience Program