Private Vocational Rehabilitation Specialist Certification Application {WKC-10042}

WKC-10042 - PRIVATE VOCATIONAL REHABILITATION SPECIALIST CERTIFICATION APPLICATION. This form is used by individuals seeking approval to provide private vocational rehabilitation services under the Wisconsin Worker’s Compensation Act. This form must be completed and submitted to the Department of Workforce Development (DWD), Worker’s Compensation Division, before an applicant may provide services to injured workers. It collects important personal, educational, and professional background information to ensure that the applicant meets the required qualifications, such as holding a recognized certification (CRC, CDMS, CVE, or a Wisconsin Professional Counselor license) or other comparable credentials. Applicants must also provide details about their vocational rehabilitation experience, professional references, and the geographic areas in Wisconsin where they will offer services. Failure to complete and submit this form for approval may result in non-payment for rehabilitation services provided to injured workers. Changes in qualification status must be reported immediately to the Worker’s Compensation Division. www.FormsWorkflow.com