Member Training - SDWP Attestation

Attention Employers of Record: If you represent more than one Member, please fill out an attestation for each of your Members. Fill out the form below and click submit. After you click submit, refresh the page and repeat for each Member.
Employer of Record (EOR)/Representative Name
Employer of Record (EOR)/Representative Name(Required)
Member Name
Member Name(Required)
Member CDTN Person ID
EOR/Representative Email
EOR/Representative Birthday
EOR/Representative Birthday(Required)
EOR/Representative Last Four Digits of Social Security Number
EOR/Representative CDTN Person ID
EOR/Representative Signature
By signing, I attest that this training was completed solely by me.
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