You are here: Home → forms

Forms

General Forms Back to top

Child Labor/ Minor's Work Permit Back to top

  • CL-1
    Child Labor Application (for 14 and 15-year-old minors)
  • eCL-3
    Online Child Labor Application (for 16 and 17-year-old workers)

  • HFLL-1
    An optional form for the certification of a serious health condition by a health care provider

Employer Forms Back to top

  • BB-1
    Basic Business Application
  • DC-1
    Summary of Workers' Compensation, Temporary Disability Insurance and Prepaid Healthcare Laws
  • LIR#27
    Application for Certificate of Compliance with Section 3-122-112, HAR
  • UC-25
    Notification of Changes
  • UC-86
    Waiver of Employer's Experience Record
  • *UC-B6
    Quarterly Wage, Contribution and Employment and Training Assessment Report
    (*Not available online - for assistance, please call 586-8915 or 586-8916)

Family Leave Back to top

  • HFLL-1
    An optional form for the certification of a serious health condition by a health care provider

Hawaii Labor and Industrial Relations Appeals Board Back to top

Hawaii Labor Relations Board Back to top

  • HLRB 1
    Petition for Certification
  • HLRB 2
    Petition for Clarification or Amendment of Appropriate Bargaining Unit
  • HLRB 3
    Petition for Decertification
  • HLRB 4
    Prohibited Practice Complaint
  • HLRB 5
    Petition for Review of Refunds
  • HLRB 6
    Statement of Objections to Conduct of Election
  • HLRB 7
    Petition Relating to Financial Report of Employee Organization
  • HLRB 8
    Petition for Determination of CB Unit and Election
  • HLRB 9
    Petition for Referendum
  • HLRB 10
    Petition for Decertification
  • HLRB 11
    Unfair Labor Practice Complaint
  • HLRB 12
    Petition for Declaratory Ruling
  • HLRB 13
    Petition for Intervention
  • HLRB 14
    Application for Issuance of Subpoenas
  • HLRB 15
    Subpoena
  • HLRB 16
    Subpoena Duces Tecum
  • HLRB 17
    Sample Format for HIOSH Initial Conference Statement

Hawaii Occupational Safety & Health Back to top

Hawaii Civil Rights Comission Back to top

Prepaid Healthcare Back to top

  • HC-4
    Health Care Coverage Questionnaire
  • HC-5  2012  |  2011
    Employee Notification to Employer
  • HC-6
    Small Employers Subject To PHC / Employer's Request for Premium Supplementation
  • HC-61
    Application For Self-Insurance Authorization

State Fire Council Back to top

Temporary Disability Insurance Back to top

  • TDI-14
    Equivalency Tables
  • TDI-15
    TDI Self-Insurer's Plan Certification & Agreement

Unemployment Insurance Back to top

Employers

  • LIR#27
    Application for Certificate of Compliance with Section 3-122-112, HAR (Use this form to request a tax clearance from the Department of Labor & Industrial Relations for Professional Service Awards)
  • BB-1
    Basic Business Application (Use this form to register your business with the Unemployment Insurance Division when employment commences)
  • *UC-B6
    Quarterly Wage, Contribution and Employment and Training Assessment Report
    (*Not available online - for assistance, please call 586-8915 or 586-8916)
  • UC-25
    Notification of Changes (Use this form to notify the Unemployment Insurance Division of any changes to an employer's address or status of business)
  • UC-336
    Election By Family Owned Corporation to be Excluded from coverage Under Section 383-7(20), HRS (Use this form to elect exclusion from unemployment insurance coverage of a family-owned corporation)
  • UC-86
    Waiver of Employer's Experience Record (Use this form to request acquisition of the experience record of a predecessor employer)

UI Claimants

  • UC-253
    Record of Contacts Made for Work
  • UC-156
    Claimant's Election to Withhold Federal/State Income Tax (Use this form to elect to have Federal and State taxes withheld.  Unemployment Insurance benefits, including Emergency Unemployment Compensation and Federal Additional Compensation are taxable income.  If you elect withholding, you are permitted only one change during your benefit year to stop withholding)
  • UC-226
    Verification of Registration for Work (You must register for work within 7 calendar days after the date you were advised to register by posting a resume online in HireNet.  You must take this form to WDD or a One-Stop office listed on the back to have Part A completed for verification of your registration for work and to have this form returned to your local unemployment office. If you will be referred to your next job by your union hiring hall, report to your union hall within 7 calendar days after filing your claim and have the union complete Part B of this form. Return the completed form to your unemployment office)
  • UC-348
    Partial Unemployment Information (Information for claimants and employers on the definition, assessment and determination of partial unemployment. Also, includes the "Verification of Partial Unemployment Status" form for employers to compete and return to confirm their employee's partial unemployment status. This form is due within 5 working days from the date the application is filed.)

 

Workers' Compensation Back to top

  • WC-1
    Employer's Report of Industrial Injury
  • WC-2
    Physician's Report
  • WC-5
    Employee's Claim for Workers' Compensation Benefits
  • WC-5A
    Dependents' Claim for Compensation
  • WC-14
    Employee's Wage Report
  • WC-21
    Application for Self-Insurance Authorization
  • WC-77
    Application for Hearing
  • WC-77a
    Response to Application for Hearing
  • LIR#27
    Application for Certificate of Compliance with Section 3-122-112, HAR


    To view and print reports you will need Adobe Acrobat Reader. If you need to download Adobe Acrobat, please click on the link.

 

 

back to top Back to top

Document Actions