The Hawaii UC 253 form is a document used by individuals applying for unemployment benefits in Hawaii. It serves as a Record of Contacts Made for Work, detailing the efforts a claimant has made to secure employment. Completing this form accurately is essential for the eligibility review process, so ensure you fill it out by clicking the button below.
The Hawaii UC 253 form, officially known as the Record of Contacts Made for Work, plays a crucial role in the unemployment insurance process for individuals seeking benefits in the state of Hawaii. This form is designed to document the job search efforts of claimants, ensuring that they actively seek employment while receiving benefits. It requires individuals to provide detailed information about their job contacts, including the date of contact, the employer's name and contact information, the method used to reach out, and the outcome of each interaction. Claimants must also indicate whether they applied for the position and provide the name of the person they contacted. This information is essential for the Unemployment Insurance Division to verify compliance with eligibility requirements. Furthermore, the form includes a certification statement that emphasizes the importance of accuracy and honesty in reporting, as false statements can lead to penalties. Completing the UC 253 form accurately is vital for maintaining eligibility for unemployment benefits and facilitating a smoother review process during eligibility interviews.
UC-253 (11/05)State of Hawaii
Department of Labor and Industrial Relations
UNEMPLOYMENT INSURANCE DIVISION
RECORD OF CONTACTS MADE FOR WORK
Record the contacts you made to obtain work that you reported on your continued claims. Please give this information to the interviewer during your Eligibility Review Interview or as requested. Your "Record of Contacts Made for Work" is subject to verification by the Unemployment Insurance Division.
Claimant's name
Social security number
Please provide the information requested or circle the appropriate response.
Date of
Employer's name, address & phone number
Method of
Name of person contacted
Position applied for
Applica-
Result of contact for
contact
tion filed?
work
Name
Telephone
Yes
Internet
Address
In person
No
Résumé
Phone
OVER - CONTINUE YOUR RECORD OF JOB CONTACTS ON THE BACK OF THIS FORM
RECORD OF CONTACTS MADE FOR WORK - CONTINUED
I certify this information is true and correct to the best of my knowledge. I am aware the law provides penalties for false statements made for the purpose of obtaining benefits.
Claimant’s signature _____________________________________________________________________________
Date _________________________________________
Hawaii Department of Taxation - The form features an Income Tax Balance Due Worksheet to help calculate any tax balance due with the extension request.
Routing Number Bank of Hawaii - Exemplifies a critical change in receiving retirement benefits enforced by the Hawaii Legislature in 2011.
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