New York > Workers Compensation
Claimants Record Of Job Search Efforts Contacts C-258 - New York
| Claimants Record Of Job Search Efforts Contacts Form. This is a New York form and can be used in Workers Compensation . |
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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 of Contact* Name and Telephone No. of Person Contacted 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) American LegalNet, Inc. www.FormsWorkFlow.com Date of Contact Employer's Name & Address Method of Contact* Name and Telephone No. of Person Contacted 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 American LegalNet, Inc. www.FormsWorkFlow.com
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