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C-258 2026

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  1. Click ‘Get Form’ to open the C-258 in our editor.
  2. Begin by entering your last name, first name, middle initial, WCB case number, and the period for which you are reporting your job search efforts.
  3. In Section 1, provide details of any participation in job-location services. Include the location, name of the program or service, and dates along with activity/results.
  4. For Section 2, if you conducted an independent job search, check the box and ensure to complete Form C-258.1 as well.
  5. In Section 3, document any participation in vocational rehabilitation programs. Fill in the date(s) of contact, name of the career center or program, and attach supporting documentation.
  6. Finally, in Section 4, if attending an accredited institution, provide enrollment dates and attach proof of enrollment.

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c258 1

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Claimants Record of Job Search Efforts/Contacts

Use this form to record efforts to obtain employment within your physical restrictions through vocational service, continued education, or an independent job

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