Forms

Child Labor/Minor’s Work Permit

  • CL-1  Child Labor Application (for 14 and 15-year-old minors)
  • eCL-3 
 Online Child Labor Application (for 16 and 17-year-old workers)

Employer Forms 

  • BB-1  Basic Business Application
  • LIR#27  Application for Certificate of Compliance with Section 3-122-112, HAR
  • UC-25  Notification of Changes
  • UC-86  Waiver of Employer’s Experience Record
  • *UC-B6  Quarterly Wage, Contribution and Employment and Training Assessment Report
    (*Not available online – for assistance, please call 586-8915 or 586-8916)

Family Leave

  • HFLL-1  An optional form for the certification of a serious health condition by a health care provider

Hawaii Labor and Industrial Relations Appeals Board

  • LIRAB 1 – Initial Conference Statement
  • LIRAB 2 – Notice of Non Hearing Motion
  • LIRAB 3 – Notice of Hearing
  • LIRAB 4 – Unnamed Witness Identification
  • LIRAB 5 – Live Witness Identification
  • LIRAB 6 – Notice of Appeal
  • LIRAB 7 – Stipulation to Continue Conference
  • LIRAB 8 – Certificate of Service
  • LIRAB 9 – Stipulation for Temporary Remand
  • LIRAB 10 – Withdrawal of Appeal
  • LIRAB 11 – Stipulation to Dismiss a Party
  • LIRAB 12 – Request Order for Transcript of Proceedings
  • LIRAB 13 – Designation of Representative
  • LIRAB 14 – Stipulation to Waive Discovery and Trial
  • LIRAB 15 – Request for Approval of Attorney’s Fee

Hawaii Labor Relations Board 

  • HLRB 1  Petition for Certification
  • HLRB 2  Petition for Clarification or Amendment of Appropriate Bargaining Unit
  • HLRB 3  Petition for Decertification
  • HLRB 4  Prohibited Practice Complaint
  • HLRB 5  Petition for Review of Refunds
  • HLRB 6  Statement of Objections to Conduct of Election
  • HLRB 7  Petition Relating to Financial Report of Employee Organization
  • HLRB 8  Petition for Determination of CB Unit and Election
  • HLRB 9  Petition for Referendum
  • HLRB 10  Petition for Decertification
  • HLRB 11  Unfair Labor Practice Complaint
  • HLRB 12  Petition for Declaratory Ruling
  • HLRB 13  Petition for Intervention
  • HLRB 14  Application for Issuance of Subpoenas
  • HLRB 15  Subpoena
  • HLRB 16  Subpoena Duces Tecum
  • HLRB 17  Sample Format for HIOSH Initial Conference Statement

Hawaii Occupational Safety & Health 

  • Advisory Board Application Form
  • Boilers & Elevators
  • Certificate of Fitness for Explosives
  • Certified Safety and Health Professional
  • Hoisting Machine Operators Advisory Board

Hawaii Civil Rights Commission

  • FORM PCQ-Employment: Pre-Complaint Questionnaire Employment
  • FORM PCQ-Access to State/Funded Services: Pre-Complaint Questionnaire
  • FORM PCQ-Public Accommodation: Pre-Complaint Questionnaire
  • FORM PCQ-Real Property Transaction: Pre-Complaint Questionnaire

Personnel

Prepaid Healthcare

  • HC-4  Health Care Coverage Questionnaire
  • HC-5  Employee Notification to Employer
  • HC-6  Small Employers Subject To PHC / Employer’s Request for Premium Supplementation
  • HC-61  Application For Self-Insurance Authorization

State Fire Council

  • SFC 1-99  Fire Inspection Report

Temporary Disability Insurance

  • TDI-14  Equivalency Tables
  • TDI-15  TDI Self-Insurer’s Plan Certification & Agreement

Unemployment Insurance (Employers)

  • LIR#27  Application for Certificate of Compliance with Section 3-122-112, HAR (Use this form to request a tax clearance from the Department of Labor & Industrial Relations for Professional Service Awards)
  • BB-1  Basic Business Application (Use this form to register your business with the Unemployment Insurance Division when employment commences)
  • *UC-B6  Quarterly Wage, Contribution and Employment and Training Assessment Report  (*Not available online – for assistance, please call 586-8915 or 586-8916)
  • UC-25  Notification of Changes (Use this form to notify the Unemployment Insurance Division of any changes to an employer’s address or status of business)
  • UC-336  Election By Family Owned Corporation to be Excluded from coverage Under Section 383-7(20), HRS (Use this form to elect exclusion from unemployment insurance coverage of a family-owned corporation)
  • UC-86  Waiver of Employer’s Experience Record (Use this form to request acquisition of the experience record of a predecessor employer)
  • Self-Financing for Non-Profit Organizations (NPO)
    Non-profit organizations (religious, charitable, and educations) qualifying for income tax exemption under the Section 501(c)(3) Internal Revenue Code may apply for exemption from paying contributions by requesting self-financing status under provisions of Chapter 383-62(d) of the Hawaii Employment Security Law.  Indian tribes or tribal units may elect to be self-financing.

Unemployment Insurance (UI Claimants)

  • UC-253  Record of Contacts Made for Work
  • UC-156  Claimant’s Election to Withhold Federal/State Income Tax (Use this form to elect to have Federal and State taxes withheld.  Unemployment Insurance benefits, including Emergency Unemployment Compensation and Federal Additional Compensation are taxable income.  If you elect withholding, you are permitted only one change during your benefit year to stop withholding)
  • UC-226  Verification of Registration for Work (You must register for work within 7 calendar days after the date you were advised to register by posting a resume online in HireNet.  You must take this form to WDD or a One-Stop office listed on the back to have Part A completed for verification of your registration for work and to have this form returned to your local unemployment office. If you will be referred to your next job by your union hiring hall, report to your union hall within 7 calendar days after filing your claim and have the union complete Part B of this form. Return the completed form to your unemployment office)
  • UC-275  Request for Withdrawal of Claim
  • UC-348  Partial Unemployment Information (Information for claimants and employers on the definition, assessment and determination of partial unemployment. Also, includes the “Verification of Partial Unemployment Status” form for employers to compete and return to confirm their employee’s partial unemployment status. This form is due within 5 working days from the date the application is filed.)

Workers’ Compensation

  • WC-1  Employer’s Report of Industrial Injury
  • WC-2  Physician’s Report
  • WC-5  Employee’s Claim for Workers’ Compensation Benefits
  • WC-5A  Dependents’ Claim for Compensation
  • WC-14  Employee’s Wage Report
  • WC-21  Application for Self-Insurance Authorization
  • WC-77  Application for Hearing
  • WC-77a  Response to Application for Hearing
  • LIR#27  Application for Certificate of Compliance with Section 3-122-112, HAR