Want to know what is the model essay on the application for arbitration of industrial injury disputes?

The model application for industrial injury labor arbitration is as follows:

Application for labor dispute arbitration

Complainant: Kai, male, Han nationality,1born in July 1986.

ID number:

Address: Wuhou District, Chengdu

Communication mode:

Agent; Lawyer of xx, xx law firm

Telephone:

Defendant: Sichuan Construction Labor Service Co., Ltd. (labor dispatching unit)

Legal Representative: xx Position: General Manager

Address: jinniu district, Chengdu.

Communication mode:

Defendant: Sichuan xx Construction Engineering Co., Ltd. (employing unit)

Legal Representative: xx Position: General Manager

Address: Wuhou District, Chengdu

Telephone:

Application items:

1. Request that the defendant pay the plaintiff's level 9 industrial injury and disability compensation totaling RMB 52,362.

2. Request for ruling that the defendant should pay the complainant 7000 yuan for follow-up treatment (confirmed by judicial expertise).

3. Ask the defendant to pay the complainant a food subsidy of 2520 yuan during the treatment of work-related injuries in the hospital.

3. Request for ruling that the defendant should pay the social insurance premiums (including basic old-age insurance, basic medical insurance, industrial injury insurance and unemployment insurance) that the complainant has insured since February 26, 2008.

4. Request to judge that the defendant should pay the employee twice the monthly salary, that is, 1 1 monthly salary compensation of 22,000 yuan, because he has not signed a written labor contract with the employee.

5. Request the defendant to pay the economic compensation of 5,000 yuan to the complainant (when the labor contract is terminated, the employee will pay one month's salary for every full year, and half a month's salary will be added for less than six months).

6. Ask the defendant to pay 24,000 yuan for overtime from February 2009 to June 2009.

Facts and reasons:

In February, 2008, X Kay was employed as a welder in Sichuan xx Construction Labor Service Co., Ltd., with a monthly basic salary of 2,000 yuan. The company promised to sign a written labor contract with him one month later. After joining the company, the company delayed signing the labor contract with various excuses and did not buy basic social security for employees. In March 2009, Kay was sent by Sichuan xx Construction Labor Service Co., Ltd. to work in the project site of Sichuan xx Construction Engineering Co., Ltd., and on June 1 14, 2009, she fell from a height of about 4 meters, causing her left foot injury. He was sent to the First Orthopedic Hospital of Chengdu and was diagnosed as "comminuted fracture of the left calcaneus", which was later recognized as a work-related injury by the administrative department of labor and social security. On June 8th, 20 10, it was appraised as Grade 9 by Chengdu Labor Ability Appraisal Committee (Cheng Lao Jian Zi [20 10] No.2457). On May 3, 20 10, it was confirmed by Southwest Sichuan Judicial Appraisal Center that "the follow-up medical expenses of the appraised person X Kai still need 7,000 yuan". According to the following legal provisions, the defendant shall bear corresponding legal responsibilities:

1. According to Articles 17 and 35 of the Regulations on Work-related Injury Insurance and the Implementation Opinions of Sichuan Provincial People's Government on Implementing the Regulations on Work-related Injury Insurance, the defendant should pay the complainant a work-related injury and disability allowance of 52,362 yuan (including: one-time disability allowance for 8 months, one-time medical subsidy and one-time disability employment subsidy 16 months).

2. According to Article 82 of the Labor Contract Law of People's Republic of China (PRC) and Article 7 of the Regulations for the Implementation of the Labor Contract Law of the People's Republic of China, if the employer fails to sign a written contract with the employee, it shall be complacent and pay the employee twice his salary standard from the next day of one month, and the complainant shall receive compensation of 22,000 yuan according to law (i.e. 1655).

3. According to the provisions of Articles 38, 46 and 47 of the Labor Contract Law of People's Republic of China (PRC), the employer shall pay economic compensation to the employee, that is, pay the employee one month's salary for every full year, and pay the employee half a month's salary for less than six months, and the complainant will receive two and a half wages compensation of 5,000 yuan.

In order to safeguard the dignity of the law and protect the legitimate interests of workers, I implore the arbitration commission to support the plaintiff's claim according to law.

Zhezhi

Chengdu Labor Arbitration Commission

Complainant:

July 26, 2065 438+00

Attachment: 1, two labor dispute arbitration applications.

2. List of evidence