Form IA12.3 at a glance
What it is: Form IA12.3 (12/25) is the Record of Employment, for Unemployment Insurance purposes only.
Where and when to file: 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.
Employer: Complete and give this form to each worker who is permanently, indefinitely, or temporarily laid off; discharged; quits; or has their hours reduced to 30 or less each week.
A filled-in Form IA12.3 example: an employer gives the record to a worker with reduced hours
How to fill out Form IA12.3, box by box
Date given to employee
Under Employer, enter the Date given to employee.
Employer name, Payroll records are kept at, Payroll or Clock No. and Location of employment or code
Enter the Employer name. Under Payroll records are kept at, fill in the Street lines, City, State and Zip. Optional if needed by employer to locate employee record: Payroll or Clock No. and Location of employment or code.
NYS Employer Registration No. and Federal Employer Identification No.
Enter the NYS Employer Registration No. and the Federal Employer Identification No.
Employee: your name and Social Security No.
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 Your name and Social Security No.
More rules for Form IA12.3
This may not be used as an identification card.
Before you go
Have the following information available when you apply: 1. Your Social Security number. 2. A valid New York State driver's license or Non-Driver Photo Identification Card number (if you have either one). 3. Your complete mailing address and Zip. 4. A telephone number, including area code, where you can be contacted Monday through Friday between 8:00am and 5:00pm Eastern Time. 5. Your Alien Registration Number (A#) or USCIS Number, if you are not a United States citizen. 6. Details about your employment for the last 18 months:
Employer names, addresses, and phone numbers (including out-of-state employers). NYS Employer Registration Number or Federal Employer Identification Number (FEIN) for each employer. The FEIN can be located 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. A copy of your Notice to Federal Employee about Unemployment Insurance, Form SF8, if you have employment with the federal government. 8. Form DD-214, member copy 4, if you have military employment. If member copy 4 is not available, you may use copy 2-3, or 5-8, or DD-215. 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 blank personal check so you may enter your bank routing and checking account numbers, if you want direct deposit of your weekly benefits. The fastest way to receive your benefits is through direct deposit. You can file a claim without all of these documents. However, missing information could delay your first payment.
Sources
[1] Form IA12.3 (12/25), Record of Employment, New York State Department of Labor (the Official source link on this page).