Michigan employer disclosure 2026

1. Click ‘Get Form’ to open the Michigan Employer Disclosure in the editor.
2. Begin by entering the employee's name and the last four digits of their Social Security Number, followed by their date of birth.
3. In Section 1, provide the full name of the employer, along with the address, city, state, and ZIP code where the employee was employed.
4. Move to Section 2 and detail the employment information. Include dates of employment and wages for each week prior to the alleged injury. If applicable, attach additional pages for comprehensive details.
5. Describe any fringe benefits received by the employee during their employment and include relevant records as specified in the form.
6. Complete all remaining sections regarding job duties, licensing requirements, job offers post-injury, and termination status. Ensure all responses are clear and concise.
7. Finally, have an employer representative sign and date the form before exchanging it among all parties involved.

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