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Click ‘Get Form’ to open the dwc 3sd wage statement in the editor.
Begin by filling in the employee's name, mailing address, and Social Security number. Ensure accuracy as this information is crucial for processing.
Next, provide the employer’s business name and mailing address. This identifies the source of the wage statement.
Indicate the employee's date of hire and date of injury. This helps establish timelines for benefits calculation.
Complete the employment status section by answering whether the employee works continuously through the calendar year. If not, specify their scheduled work dates.
Fill out either the Written Contract Wage Information or Wage Information for Salaried, Hourly, Daily, & Other Non-Contract Employment based on the employee's contract status.
Finally, certify that all information is complete and accurate by signing and dating at the bottom of the form before submitting it to your carrier.
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List the amount of nonpecuniary wages in each pay period before the date of injury. Nonpecuniary wages are noncash benefits such as education fees or uniforms.Read more
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