Meggesto, Crossett & Valerino, LLP

Job Search (C-258) Form Generator

Your Information
Full Name
Workers’ Compensation Board Case Number
Under New York State Workers’ Compensation Law, injured workers who have a partial disability have an obligation to look for work within the restrictions provided by their doctor. Failing to provide evidence of labor market attachment to the New York Workers’ Compensation Board can allow the insurance carrier to stop ongoing weekly wage benefits.
This Job Search Form Generator allows injured workers to easily keep track of their work search efforts so that they meet their obligation under the New York Workers’ Compensation Law. Examples of information that should be input to the form are: independent job searches, enrollment with ACCES-VR, and contact with One Stop Centers.

To complete this form, follow these instructions:
•    Fill in your name and WCB case number above.
•    Enter the name and address of the employer that was contacted for employment opportunities.
•    Enter the date and method of contact. If you spoke with a specific person at the prospective employer, input that person’s name and contact information in the appropriate fields.
•    Enter the position applied for and the result of the contact if any.
•    Click “Add” and repeat above process to simply add additional job searches.
•    When finished adding all individual job searches, click “Generate Form” to complete the process and generate your Job Search form to be printed (the information you entered will not be saved by us).