C 258 Form PDF Details

In the realm of workers' compensation in New York State, the journey to ensuring that benefits are allocated accurately and justly to those in need is complemented by the utilization of the C-258 form, formally known as the Claimant's Record of Job Search Efforts/Contacts. This document plays a pivotal role for individuals who are in the process of recovering from an injury and are receiving workers' compensation benefits. The form serves as a structured method for claimants to officially record and verify their endeavors to find employment amidst their recovery phase. By meticulously listing details such as the dates of contact with potential employers, the names and addresses of these entities, methods of communication, and the outcomes of these engagements, the form ensures that there's a transparent account of the claimant's efforts to reintegrate into the workforce. This documentation is crucial, not just for the sake of record-keeping, but as a tangible proof that can be assessed during hearings, potentially influencing the continuation, adjustment, or conclusion of benefits. The explicit instruction to attach supplementary evidence like resumes, inquiry letters, and email communications further underscores the importance of a well-documented job search endeavor. Hence, the C-258 form embodies a critical tool in the nexus of workers' recovery, their reentry into the labor market, and the meticulous processes governing workers' compensation benefits.

QuestionAnswer
Form NameC 258 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesnys, wcb, c258 1 form, job search contact list printable

Form Preview Example

STATE OF NEW YORK - WORKERS' COMPENSATION BOARD

CLAIMANT'S RECORD OF JOB SEARCH EFFORTS/CONTACTS

CLAIMANT'S NAME

WCB CASE NO.

This form is to assist you in an independent job search. List all the employers, employment agencies and labor unions you have contacted while receiving workers' compensation benefits. You may be asked to present a list to evaluate your work search efforts at a hearing. If you run out of space on these sheets, you should continue your list on separate sheets of paper. Attach copies of resumes, inquiry letters, email communications and applications completed in connection with these efforts.

Date of Contact

Employer's Name & Address

Method

Name and Telephone No.

of

of Person Contacted

Contact*

 

 

 

Position

Applied For

Was

Application

Taken?

Result of

Contact

* T = Telephone, P = In Person, R = Resume, E = E-mail, L = Letter, A = Employer's Application

C-258 (8-10)

Date of Contact

Employer's Name & Address

Method

Name and Telephone No.

of

of Person Contacted

Contact*

 

 

 

Position

Applied For

Was

Application

Taken?

Result of

Contact

* T = Telephone, P = In Person, R = Resume, E = E-mail, L = Letter, A = Employer's Application

C-258 (8-10) Reverse

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Step number 1 for filling out job search contact list printable

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T Telephone P In Person R , T Telephone P In Person R , and T Telephone P In Person R in job search contact list printable

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