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Workers' Compensation Board

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Application Form and Instructions on How to Become a Licensed Representative

The Licensed Representative Examination Process

Please contact the Licensing Office at 1-800-664-2379 for information as to when the next written exam will be held, along with the registration deadline date.

Licensed Representatives Regulations

Application Form and Examination Guide for Licensing Representative Exam
Form Number / Version Date Form Title Who Files When to File
OC-409 (05/99) adobe pdf
Exam Guideadobe pdf
Initial Application to Take License Representative Exam This form is to be completed by individual taking exam. Complete applications accompanied by the required fee are due by close of business Wednesday, April 30, 2014.