Virgin Islands Department of Labor

Official Government of the Virgin Islands Website

FORMS

This page provides our downloadable departmental forms.

If you do not see a form or need more information,  Contact Us.

Please Note:  Job orders are now easy and simple to submit ONLINE. 

Post your job orders by logging in and using our VIeWS system.

If you are having trouble, one of our Business Representatives can assist you.

Authorization to Release Medical Records
Used to disclose all medical records or other information regarding my treatment, hospitalization and/or outpatient.

Claim for Compensation on Account of Death
Used to claim compensation in the event of death.

Employee’s Claim for Compensation for Disability
Used by employees to claim compensation for disability.

Conditions Governing Death Benefits
Claim for compensation on account of death form should be completed and forwarded to this Office accompanied by the following documents.

Memorandum
Employer’s Insurance Certificate

Employer’s First Report and Employee’s Notice of Injury or Occupational Illness
Used to provides information on the claimant, employer, insurance carrier and medical practitioner necessary to begin the claims process.

Standard Form for Surgeon’s Report
Surgeon’s Report. 

Unemployment Insurance Business Status Change
Used to notify Unemployment Insurance of changes in legal form, closing of operations, transfers, or locale of operations.

New Hire Reporting
Used by employers to report hiring of new personnel.

Employer Wage and Contribution Report
Used to file unemployment insurance quarterly wage and hour contributions.

Worker Opportunity Tax Credit ETA 9061
Individual characteristics form used together with IRS 8850 to determine eligibility for tax credit

Unemployment Insurance Employer Registration
Employer Registration for Unemployment Insurance

Worker Opportunity Tax Credit ETA form 8850
Application form used for obtaining Worker Opportunity Tax credit.

Multiple Worksite Report Form
The Multiple Worksite Report (MWR) form is used to collect employment and wages by individual work location in the Virgin Islands.

Youth Service Application
This form is used for proposals for Youth Workforce Development Services authorized through the Workforce Innovation and Opportunity Act of 2014 (WIOA).

Virgin Islands Division of  Occupational Safety & Health  Consultation Request 
VI Division of Occupational Safety and Health (VIDOSH) On-Site Consultation Program offers no-cost and confidential occupational safety and health services to public sector U.S. Virgin Islands Government Departments and Agencies.

Employer Unemployment Insurance  Appeal
This form is used by employers to appeal UI determination.

Unemployment Insurance Employer  Account Update 
This form provides the UI Tax Unit with accurate and current details about your business.

Interstate  Assistance Package
Used by individuals no longer residing in the territory to file for Unemployment Insurance

Wrongful Discharge Form
Complete this application if you believe that you were wrongfully discharged from your job.

Wage Claim
Used to file the claim when there is an alleged violation of wage and hour laws

Employment Discrimination
Used by the employee to file the claim of employment discrimination in the workplace.

OSHA Complaint Form
Used by any employees or representatives of employees who believe that a violation of a safety or health standard exists that threatens physical harm, or that an imminent danger exists.

2024 Summer Youth Work Experience Program
Application for those seeking summer work experience. 

2024 LIFT Program Application
Labor Investing For Tomorrow application.

2024 Career Exploration
A 4-week Career Exploration program targeting youths 14-15-years-old.

Summer Work Experience Participant Handbook
Customer manual for those participating in the Summer Youth Work Experience Program

Summer Work Experience Supervisor’s Handbook
Supervisor manual for those participating in the Summer Youth Work Experience Program

Summer Employment Employer Request Form
Providers, please use this form to request students for the Summer Work Experience Program