South Dakota > Workers Compensation
Request For Conciliation - South Dakota
| Request For Conciliation Form. This is a South Dakota form and can be used in Workers Compensation . |
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SOUTH DAKOTA DEPARTMENT OF LABOR DIVISION OF LABOR AND MANAGEMENT , Petitioner, vs. , Respondent. HF No. REQUEST FOR CONCILIATION 1. Employee or Employee Organization: Name of contact person: Address: Telephone: Employer Name of contact person: Address: Telephone: Date written statement of Impasse delivered: Contracts Issued: Yes No 2. 3. 4. 5. 6. Place where meeting can be held: Brief statement of nature of impasse: _______________________________ Signature of Person or Organization requesting Conciliation DOL-LM 8/02 1
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