Return to Work - CALIFORNIA STATEWIDE JURISDICTION TEAMSTERS LOCAL UNION 896

CALIFORNIA STATEWIDE JURISDICTION TEAMSTERS LOCAL UNION 896

Returning to Work (RTW)

* Indicates required field

Name *

First

Last

Phone Number *

Address *

City *

Zip Code *

Last 4 of SS# *

Employer & Location *

Your Return Date (Example: 01/01/2016) *

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