Free UCS-6B - Florida

Employee Notice for Unemployment Compensation Coverage (Employer's Reciprocal Coverage Election)

UCS-6B R. 07/07

Social Employee'sName: ______________________________________ SecurityNo.:





--



--







ResidenceAddress:_____________________________________________________________________________________ City,StateZIP: _________________________________________________________________________________________ _ Effectiveasof___________________20_____,anduntilfurthernotice,theFloridaunemploymentcompensation lawwillbethelawwhichappliestoallworkyouperformfortheundersignedemployer,inanyorallofthefollowing jurisdictions: ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ThiswillbetrueunderanelectiondulyfiledbytheundersignedemployerandapprovedbythestateofFlorida, DepartmentofRevenue,towhichtheotherjurisdictionslistedabovedulyconsented. Ifyoubecomeunemployed,andliveinFlorida,youcanfileyourunemploymentclaimthroughtheInternetat https://www2.myflorida.com/apps/uc/fluid/.ShouldyoubeunabletofileyourclaimthroughtheInternet, pleasecontactthenearestOneStopCareerCenterforfurtherinstructionsonhowtofileyourclaim. Ifyouliveinanotherstate,youcanfilethroughtheInternetathttps://www2.myflorida.com/apps/uc/fluid, oryoumayfileyourclaimbycalling800-318-0133.Shouldyoubeunabletofileyourclaimthrougheitherthe Internetorbytelephone,pleasecontactthenearestOneStopCareerCenter,orit'sequivalent,inthestatewhere youlive. Savethisnoticeincaseitisneeded,ifandwhenyoufileaclaimforbenefits. Firm-NameofEmployer: _____________________________________________________________________________ Employer'sFloridaUnemploymentTaxAccountNo.:
--

Datethisnoticeisgivenormailedtotheemployee: M M D D Y Y Y Y Theemployermustcompleteatleasttwocopiesofthisnotice,anddistributethemasfollows: 1. Onecopymustbedelivered(ormailed)totheemployee. 2. Onecopymustbesenttothe: Florida Department of Revenue PO Box 6510 Tallahassee FL 32314-6510

/

/

Iunderstandandagreetotheabovestatements. _______________________________________________________________ (SignatureofEmployee) www.myflorida.com/dor