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Form Number Form Title Form Language DWD Division Creation/Revision Date Content Contact
ERD-10110 Family and Medical Leave Request English ER 1/1/2010 Equal Rights Information 
ERD-10111 Physician or Practitioner Certification for Family or Medical Leave English ER 11/1/2005 Equal Rights Information 
ERD-10111-S Physician or Practitioner Certification for Family or Medical Leave Spanish ER 11/1/2005 Equal Rights Information 
ERD-10240 Discrimination Complaint- Fair Housing English ER 10/1/2002 Equal Rights Information 
ERD-10241-E Discrimination Complaint - Publication Accommodation or Amusement English ER 10/1/2002 Equal Rights Information 
ERD-10584 Agent or Subcontractor Affidavit of Compliance with Prevailing Wage Rate Determination English ER 8/1/2003 Equal Rights Information 
ERD-10880 Request to Employ Subjourneyperson English ER 10/1/2004 Equal Rights Information 
ERD-12192 Employment Agent's Registration English ER 6/1/2006 Equal Rights Information 
ERD-12193 Cessation of Health Care Benefits Complaint English ER 3/1/2001 Equal Rights Information 
ERD-13485 Compliance Report Checklist English ER 6/5/2003 Equal Rights Information 
ERD-13521 Retaliation Complaint - Elder Abuse/Health Care Worker Laws English ER 4/1/2004 Equal Rights Information 
ERD-13593 Retaliation Complaint - Public Employee Health and Safety Law English ER 2/1/2003 Equal Rights Information 
ERD-13594 Retaliation Complaint - Employee Right to Know About Toxic Substances or Infectious Agents on the Job English ER 2/1/2003 Equal Rights Information 
ERD-13595 Discrimination Complaint - In Post-Secondary Education Based on Physical Condition or Developmental Disability English ER 2/1/2003 Equal Rights Information 
ERD-13859-E Retaliation Complaint - Whistleblower Law for State of Wisconsin Employees English ER 8/7/2003 Equal Rights Information 
ERD-15614-E Home Care Worker Notice English ER 4/26/2007 Equal Rights Information 
ERD-15615-E Home Care Consumer Notice English ER 5/9/2007 Equal Rights Information 
ERD-4206-E Discrimination Complaint - Fair Employment English ER 5/1/2009 Equal Rights Information 
ERD-4971-E Request to Withdraw Complaint English ER 3/1/2009 Equal Rights Information 
ERD-4972 Medical Release Authorization English ER 2/1/2005 Equal Rights Information 
ERD-5719 Application for Prevailing Wage Rate Determination English ER 1/4/2009 Equal Rights Information 
ERD-5721-E Local Union Wage and Employment Report English ER 7/1/2008 Equal Rights Information 
ERD-5724 Prime Contractor Affidavit of Compliance with Prevailing Wage Rate Determination English ER 11/1/2005 Equal Rights Information 
ERD-7777-E Disclosure of Ownership English ER 2/1/2009 Equal Rights Information 
ERD-8994-E Family and Medical Leave Complaint English ER 3/18/2008 Equal Rights Information 
ERD-8994-S Family and Medical Leave Complaint Spanish ER 3/18/2008 Equal Rights Information 
ERD-9256 Application for a Wisconsin Rehabilitation Facility/Sheltered Workshop License English ER 2/28/2008 Equal Rights Information 
ERD-9646 Business Closing/Mass Layoff Complaint English ER 8/8/2005 Equal Rights Information 
ERD-9850 Wisconsin Prevailing Wage Complaint English ER 12/1/2000 Equal Rights Information 
LS-11 Monthly Permit Officer Report English ER 7/18/2005 Equal Rights Information 
LS-119-E Wisconsin Labor Standards Complaint English ER 10/1/2009 Equal Rights Information 
LS-119-S Wisconsin Labor Standards Complaint Spanish ER 10/1/2009 Equal Rights Information 
LS-37 Application for a Special Minimum Wage License - NOTE: includes both a Microsoft Word Fill-enabled version to be filled out on your computer, and a PDF version for printing and manual completion. English ER 1/1/2004 Equal Rights Information 
LS-86A-E Renewal Application - Employment Agent's License English ER 6/1/2008 Equal Rights Information 
LS-86-E Initial Applicaiton - Employment Agent's License English ER 11/1/2007 Equal Rights Information 

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