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Click ‘Get Form’ to open it in the editor.
Begin by entering your name and claim number at the top of the form. This ensures that your submission is correctly associated with your case.
In the Employment History section, list your jobs for the past three years, starting with the most recent. Include self-employment and volunteer work as well.
For each job, specify the dates of employment (month/year), wages, and any additional earnings. Be sure to indicate if you received unemployment benefits during any gaps in employment.
If applicable, provide details about employer contributions to medical insurance and any reimbursements for board or housing.
Finally, review all entered information for accuracy before signing and dating the form at the bottom.

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What is the statute of limitations on LI in Washington state?

Washington State LI Statutes. of Limitations Explained In the land of Labor and Industries, occupational disease claims have a two-year filing time limit, while you only get one year to file industrial injury claims.

What is the maximum time loss rate for LI?

Maximum time-loss rate: In Washington, the maximum LI time-loss rate for 2025 is $8,913.80 per month. For details see LIs Maximum Time Loss Rate.

How long can you be on workers comp in Washington?

How long you can get workers comp in every state StateTemporary total disability length Washington Until MMI or you can return to work West Virginia 104 weeks Wisconsin Until MMI Wyoming 104 weeks47 more rows Mar 31, 2023

How much is the LI injury payout in Washington state?

The benefit amount is 60 to 75% of the wage you were earning, depending on how many dependents you have. The minimum and maximum LI can pay is set by the state legislature. You may have better options available - ask your employer if there are other jobs you can do to earn your wage or salary while you recover.

How long can you collect LI in Washington state?

How to write employment history on a resume List your jobs in order. Include the name and location of the company. Provide your job title . Specify the dates of employment. List your most important accomplishments and responsibilities. Highlight awards.

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F242-109-000 employment history form - Labor & Industries - lni wa 2026

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What is the statute of limitations on LI in Washington state?

What is the maximum time loss rate for LI?

How long can you be on workers comp in Washington?

How much is the LI injury payout in Washington state?

How long can you collect LI in Washington state?

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F242-109-000 employment history form - Labor & Industries - lni wa 2026

Here's how it works

How to use or fill out F242-109-000 employment history form - Labor & Industries - lni wa with our platform

See more F242-109-000 employment history form - Labor & Industries - lni wa versions

Complete this form in 5 minutes or less

Got questions?

What is the statute of limitations on LI in Washington state?

What is the maximum time loss rate for LI?

How long can you be on workers comp in Washington?

How much is the LI injury payout in Washington state?

How long can you collect LI in Washington state?

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