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Form Ucs-6b - Employee Notice For Unemployment Compensation Coverage (Employer'S Reciprocal Coverage Election - Florida Department Of Revenue

UCS-6B

R. 12/00

Employee Notice

for Unemployment Compensation Coverage

(Employer’s Reciprocal Coverage Election

Employee’s Name __________________________________________________ Social Security No. __________________

Residence Address ____________________________________________________________________________________

Effective as of ___________________ 20_____, and until further notice, the Florida Unemployment Compensation Law will be the

law which applies to all work you perform for the undersigned employer, in any or all of the following jurisdictions:

____________________________________________________________________________________________________

This will be true under an election duly filed by the undersigned Employer and approved by the State of Florida Department of

Revenue, to which the other jurisdictions listed above duly consented.

If you become unemployed, no matter where you may then be, you should file a claim at the nearest unemployment

compensation claims office for benefits under the Florida Law.

SAVE THIS NOTICE, and present it at the unemployment compensation claims office, if and when you file a claim for

benefits.

Firm-Name of Employer _________________________________________________________________________

Employer’s Florida Account No. ___________________________________________________________________

Date this notice given (or mailed) to Employee _______________________________________________________

The employer must complete at least two copies of this notice, and distribute them as follows:

One copy must be delivered (or mailed) to the Employee.

One copy must be sent to the DEPARTMENT OF REVENUE

PO BOX 6510

TALLAHASSEE FL 32314-6510

I understand and agree

to the above statements.

(Signature of Employee)

INTERNET ADDRESS:

Form Ucs-6b - Employee Notice For Unemployment Compensation Coverage (Employer'S Reciprocal Coverage Election - Florida Department Of Revenue