NYS Record Employment Form PDF Details

The New York State Record Employment form serves as a crucial document for both employers and employees within the realm of Unemployment Insurance (UI). It is specifically designed for use exclusively within the Unemployment Insurance Division, emphasizing its importance in the UI process. When an employee either quits, is laid off, or is discharged, the employer is mandated to complete this form and provide it to the departing employee. This form includes vital details such as the date it was given to the employee, NYS Employer Registration Number, and Federal Employer Identification Number, alongside the employer’s and payroll records address. For employees, this certificate acts as proof of their insured employment status, although it clarifies that holding the certificate alone does not guarantee qualification for unemployment benefits. This is determined upon applying for UI benefits, for which the form also offers guidance. It outlines the necessary steps and required information for applying for UI benefits, serving as a roadmap for unemployed workers seeking temporary financial relief. The emphasis on preparedness for the application process indicates the document’s role in streamlining access to unemployment benefits, thus underscoring its importance in the broader framework of employment and unemployment insurance in New York State.

QuestionAnswer
Form Name NYS Record Employment Form
Form Length 1 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 15 sec
Other names ny dol record of employment, nys record of employment, new york record of employment form, ia 12 3

Form Preview Example

Unemployment Insurance Division

Record of Employment

(For Unemployment Insurance purposes only.)

Employer: Complete the following and give this form to every employee who quits, is laid off, or is discharged:

Date given to employee:

//

NYS Employer Registration No.:

-

Federal Employer Identification No.:

-

Employer Name:________________________________________________

Payroll Records are kept at:_______________________________________

Street:________________________________________________________

Street:________________________________________________________

City:__________________________________ State:_______ Zip:________

Optional if needed by employer to locate employee record:

Payroll or Clock No.: ______________ Location of employment or code: __________________________________

Employee: Keep this certificate. Have it with you if you apply for Unemployment Insurance (UI) benefits. This certificate shows that your job was insured. It does not necessarily mean you qualify for benefits. The UI Claims Center will make that determination if you apply. Please complete the following:

Your Name: ____________________________________________ Social Security No.:--

This may not be used as an identification card.

IA 12.3 (01/18)

How to Apply For New York State Unemployment Insurance

Unemployment Insurance is temporary income for eligible workers who are out of work through no fault of their own. It provides them a weekly benefit while they look for work. If you become unemployed and want to apply for Unemployment Insurance benefits, apply online at www.labor.ny.gov for a quick and convenient way to file your claim or call the Telephone Claim Center toll free at (888) 209-8124.

Have the following information available when you apply:

1.Your Social Security Number.

2.Your NYS Driver License or Motor Vehicle ID card (if you have either one).

3.Your complete mailing address and zip code.

4.A phone number, including area code, where we can reach you from 8:00 am – 5:00 pm, Monday – Friday.

5.Your alien registration card (if you are not a US citizen and have a card).

6.Employer information (even employers in other states) for the last 18 months which includes:

•Employer names, addresses, and phone numbers.

•NYS Employer Registration Number or Federal Employer Identification Number (FEIN). The FEIN

is on your W-2 form(s).

•Your total gross earnings (before any deductions) for each employer. You may be asked for pay stubs, W-2 forms, or other payment records.

7.Your copies of “Notice to Federal Employee about Unemployment Insurance” (Form SF8) and “Notification of Personnel Action” (Form SF50) if you were a federal employee.

8.Your most recent separation form (DD214) and any DD215 forms you have received from military service. You can request a DD 214 through the U.S. National Archives and Records Administration website at: http://www.archives.gov/st-louis/military-personnel/standard-form-180.html.

9.A check from your personal checking account so you can provide your bank’s routing number and your checking account number if you choose Direct Deposit of your weekly benefits.

You can file a claim without all of these documents. However, missing information could delay your first payment.

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