Direct Payment for Insurance Eligibility: Attestation of Availability for Employment by Contributing Employers

Direct Payment for Insurance Eligibility: Attestation of Availability for Employment by Contributing Employers

West Virginia Laborers' Trust Fund
I hereby attest that I hold myself as eligible and available for employment by contributing employers and will continue to hold myself as eligible and available for employment by contributing employers in order to continue to make direct payments. I will notify the Fund Office if I should no longer meet these requirements.
Name

First Name Last Name
Date

Month Day Year
Date
Signature

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