Authorization of release of unemployment records form: Fill out & sign online

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Click ‘Get Form’ to open the authorization for release of unemployment insurance records form in the editor.
Begin by entering your name in the designated field where it states 'PRINT YOUR NAME'. This identifies you as the individual authorizing the release.
In the section labeled 'TO:', provide the name and title of the appointing entity, along with their mailing address, city, state, and ZIP code. Ensure this information is accurate for proper processing.
Next, enter today's date in the 'Date:' field. This is crucial as it indicates when your authorization becomes effective.
Sign your name in the 'RETIRED ANNUITANT SIGNATURE' area to validate your consent. Remember, this authorization remains valid for 12 months from this date.
Fill in your Social Security Number and Date of Appointment as required. These details are necessary for identification purposes.
If applicable, check either 'YES' or 'NO' regarding whether UI benefits were paid to you in the last 12 months. If yes, provide additional details as prompted.

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