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NEW YORK STATE DEPARTMENT OF LABOR CONTINUATION OF EMPLOYMENT RECORD SW 330.2 (06>01)
NEW YORK STATE DEPARTMENT OF LABOR
CONTINUATION OF EMPLOYMENT RECORD
SW 330.2 (06>01)
YOUR SOCIAL
SECURITY
ACCT. NO.
PLEASE DO NOT WRITE IN THIS BOX
LOCAL OFFICE USE ONLY
L.O. NO.:
EFF. DATE:
YOUR
NAME
FIRST NAME
MIDDLE INITIAL
LAST NAME
CONTINUE BELOW THE LIST OF YOUR EMPLOYERS DURING THE LAST 18 MONTHS. PLEASE PRINT
Company Name of Employer
Dates Worked

From
Through
Payroll Address
Telephone No.
Mo. Day Yr. Mo. Day Yr.
( )
CityState
Zip Code
Work Location (
if Maritime Worker Show
Return to Work

Article No. & Name of Ship)

Date
REASON FOR SEPARATION
Lack of Work Fired Quit Occupation on This Job
Pension from
Strike, Lockout or Labor Dispute
this employer?
Yes
No
Educational Institution?
Yes
No If federal: SF8 used? Yes
No
Full time Part time/intermittent
Company Name of Employer
Dates Worked

From
Through
Payroll Address
Telephone No.
Mo. Day Yr. Mo. Day Yr.
( )
CityState
Zip Code
Work Location (
if Maritime Worker Show
Return to Work

Article No. & Name of Ship)

Date
REASON FOR SEPARATION
Lack of Work Fired Quit Occupation on This Job
Pension from
Strike, Lockout or Labor Dispute
this employer?
Yes
No
Educational Institution?
Yes
No If federal: SF8 used? Yes
No
Full time Part time/intermittent
Company Name of Employer
Dates Worked

From
Through
Payroll Address
Telephone No.
Mo. Day Yr. Mo. Day Yr.
( )
CityState
Zip Code
Work Location (
if Maritime Worker Show
Return to Work

Article No. & Name of Ship)

Date
REASON FOR SEPARATION
Lack of Work Fired Quit Occupation on This Job
Pension from
Strike, Lockout or Labor Dispute
this employer?
Yes
No
Educational Institution?
Yes
No If federal: SF8 used? Yes
No
Full time Part time/intermittent
Company Name of Employer
Dates Worked

From
Through
Payroll Address
Telephone No.
Mo. Day Yr. Mo. Day Yr.
( )
CityState
Zip Code
Work Location (
if Maritime Worker Show
Return to Work

Article No. & Name of Ship)

Date
REASON FOR SEPARATION
Lack of Work Fired Quit Occupation on This Job
Pension from
Strike, Lockout or Labor Dispute
this employer?
Yes
No
Educational Institution?
Yes
No If federal: SF8 used? Yes
No
Full time Part time/intermittent