Instructions: Edit any information below and click "Export Word" to generate the document.
[[formData.formTitle]]
Restricted Duty Job Description
Descripción del trabajo restringido
| Employee Name: | Date: | ||
|---|---|---|---|
| Employer: | [[formData.claimField]]: | ||
| Nonprofit Organization: | Job Title | ||
| Associate #: | |||
| Employee's Current Restrictions: | |||
| Job Duties: | |||
| Nombre del empleado: | Fecha: | ||
|---|---|---|---|
| Empleador: | [[formData.claimField]]: | ||
| Organización Sin Fines de Lucro: | Nombre Del Puesto: | ||
| Asociado #: | |||
| Restricciones Actuales de Empleado: | |||
| Responsabilidades de trabajo: | |||
To be signed by Employee and NPO Representative and returned to TWS on first day of volunteer assignment
I, [[formData.employeeName]], fully understand my restrictions and the above outlined job duties. It is up to me to be mindful of my physical limitations while participating in the light duty work program. If I feel that I am unable to complete a tasked job duty, I will express my concerns to my nonprofit supervisor.
| Employee Signature | Date | NPO Representative Signature | Date |
Fax to: 1-800-640-0674 OR Email to: rtw@twsworks.com
To be signed by Employee and NPO Representative and returned to TWS on first day of volunteer assignment
Yo, [[formData.employeeName]], entender completamente mis restricciones y los deberes de trabajo descritos anteriormente. Depende de mí ser consciente de mis limitaciones físicas mientras participaba en el programa de trabajo ligero. Si siento que no puedo completar un deber de trabajo encargado, expresaré mis preocupaciones a mi supervisor sin fines de lucro.
| Employee Signature | Date | NPO Representative Signature | Date |
Fax to: 1-800-640-0674 OR Email to: rtw@twsworks.com