Record of Employment Form for Unemployment Insurance Benefits (UIB)

As a result of COVID-19, the New York State Department of Labor (DOL) has emphasized adherence to a regulation that directs all employers to provide employer identification information to employees who are separating from service.

All employees who separate from CUNY service will receive from Human Resources (HR) the attached pre-populated “Record of Employment” form (Form IA 12.3) in addition to any other related documents, such as a termination or non-reappointment letter.  The form, which may be delivered by email, represents the extent of the information the College is required to provide employees separating from service who are considering applying for unemployment insurance (UI) benefits.

 For any further questions, current or former employees may refer to the DOL website (  and telephone number [(888) 209-8125] both of which are also listed on the form.  Please be advised that in providing this information, the College is not deciding on an individual’s eligibility to receive UI benefits.  The UI benefits claims center will make that determination.

A copy of the form is available on HR’s website at:

If you have any questions, please feel free to contact Human Resources at .

Thank you.

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