Form HRD319B "Hawaii Residency Requirement Acknowledgment Form" - Hawaii

What Is Form HRD319B?

This is a legal form that was released by the Hawaii Department of Human Resources Development - a government authority operating within Hawaii. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 25, 2007;
  • The latest edition provided by the Hawaii Department of Human Resources Development;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form HRD319B by clicking the link below or browse more documents and templates provided by the Hawaii Department of Human Resources Development.

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Download Form HRD319B "Hawaii Residency Requirement Acknowledgment Form" - Hawaii

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HRD 319b
Revised: 7/25/07
HAWAII RESIDENCY REQUIREMENT ACKNOWLEDGMENT FORM
(To be completed on a new employee's first day of work)
Act 52 was passed by the State of Hawaii Legislature and signed into law in 2007. Under this law, employees of the State
of Hawaii who are not currently residents are required to become residents of the State of Hawaii within thirty (30) days
after beginning their employment. "Resident" is defined as a person who: 1) is physically present in the State and 2)
shows intent to make Hawaii their primary residence.
Please initial the appropriate line, then sign and date this form.
I am currently a resident of the State of Hawaii.
I hereby swear (or affirm) that I am a resident of the State of Hawaii and that the following is my
residence address (a temporary residence address is permissible, but a P.O. Box is not):
City
Address
State
Zip Code
I understand that being a resident of the State of Hawaii is a condition of my continued employment
with the State.
I also understand that residency in Hawaii means that it is my intent to make Hawaii my home. Making
Hawaii my home means that it is the place to which I intend to return to whenever I am absent.
I understand that Hawaii residency carries with it various rights and responsibilities, including, for example
(but not limited to}: my responsibility to pay Hawaii State resident income taxes, and my right to register to
vote in Hawaii if I am otherwise qualified.
I will become a resident of the State of Hawaii within thirty (30) days from the date I start my
employment.
I have read and understand the above residency requirement. I acknowledge that I have received a copy
of the Certification of Hawaii Residency (HRD 319a rev. 7/01/07) from my Department Personnel
representative on _____ _
[f oday's Date]
I understand and acknowledge that I must complete and return the Certification of Hawaii Residency
-------
(HRD 319a rev. 07/01/07) form within thirty (30) days from my first day of work or by
[Date Due}
to my Dept. Personnel representative.
I understand and acknowledge that if I do not complete and return these forms by the due dates stated
above; steps will be taken to terminate my employment.
Signature
Print or Type Name
Date Signed
City
State
Warning: Any person who knowingly furnishes false information to state government authorities may be guilty of a misdemeanor, punishable by up to 1
year of imprisonment and/or a $2,000 fine. Hawaii Revised Statutes§ 710-1063 (1993).
HRD 319b
Revised: 7/25/07
HAWAII RESIDENCY REQUIREMENT ACKNOWLEDGMENT FORM
(To be completed on a new employee's first day of work)
Act 52 was passed by the State of Hawaii Legislature and signed into law in 2007. Under this law, employees of the State
of Hawaii who are not currently residents are required to become residents of the State of Hawaii within thirty (30) days
after beginning their employment. "Resident" is defined as a person who: 1) is physically present in the State and 2)
shows intent to make Hawaii their primary residence.
Please initial the appropriate line, then sign and date this form.
I am currently a resident of the State of Hawaii.
I hereby swear (or affirm) that I am a resident of the State of Hawaii and that the following is my
residence address (a temporary residence address is permissible, but a P.O. Box is not):
City
Address
State
Zip Code
I understand that being a resident of the State of Hawaii is a condition of my continued employment
with the State.
I also understand that residency in Hawaii means that it is my intent to make Hawaii my home. Making
Hawaii my home means that it is the place to which I intend to return to whenever I am absent.
I understand that Hawaii residency carries with it various rights and responsibilities, including, for example
(but not limited to}: my responsibility to pay Hawaii State resident income taxes, and my right to register to
vote in Hawaii if I am otherwise qualified.
I will become a resident of the State of Hawaii within thirty (30) days from the date I start my
employment.
I have read and understand the above residency requirement. I acknowledge that I have received a copy
of the Certification of Hawaii Residency (HRD 319a rev. 7/01/07) from my Department Personnel
representative on _____ _
[f oday's Date]
I understand and acknowledge that I must complete and return the Certification of Hawaii Residency
-------
(HRD 319a rev. 07/01/07) form within thirty (30) days from my first day of work or by
[Date Due}
to my Dept. Personnel representative.
I understand and acknowledge that if I do not complete and return these forms by the due dates stated
above; steps will be taken to terminate my employment.
Signature
Print or Type Name
Date Signed
City
State
Warning: Any person who knowingly furnishes false information to state government authorities may be guilty of a misdemeanor, punishable by up to 1
year of imprisonment and/or a $2,000 fine. Hawaii Revised Statutes§ 710-1063 (1993).