Carvana Logistics specialist

Initial Claim Filing Summary

Claim Confirmation Number: 116136238

(1)

Claimant Information Summary

ANDREW HALBERT 3519 DUBARRY CT INDIANAPOLIS IN 46226-6044 DATE OF BIRTH: 03/05/1961 DISABLED: No

SSN: XXX-XX- 3450 VETERAN: No

EDUCATION LEVEL: 12 - Twelfth Grade CITIZEN: Yes

ETHNICITY: Not Hispanic Or Latino ALIEN REGISTRATION NUMBER: GENDER: Male EXPIRATION DATE:

RACE: Black/African American

Monetary Information Summary

Have you applied for benefits in another state at any time since 10/02/2022? No Did you receive worker's compensation at any time from 04/01/2022 to 03/31/2023? No Employment History Summary

CARVANA LOGISTICS LLC, 1930 W RIO SALADO PKWY TEMPE AZ 85281-2207 Did you work for this employer? Yes

Which of the following scenarios best describes your separation from this employer? You indicated that you were

fired, terminated, or discharged

because this employer said that

you had poor attendance.

What was your approximate start date with this employer? 10/11/2021 What is your latest date of separation from this employer? 06/14/2023 What was your rate of pay with this employer? $18.00 per Hour How many hours did you normally work per week with this employer? 40 How many days did you normally work per week with this employer? 5 Select the option that best describes your employment with this employer Full-Time What was your job title? logistic specialist

Claim Confirmation Number: 116136238

(2)

Income Summary

Other Income

You indicated you are not receiving any non-wage payments. Strike or Sub Pay

You indicated that you are not receiving Sub Pay.

You indicated that you are not receiving Strike Pay. Social Security, Social Security Disability, and Disability Pay You indicated that you are not receiving Disability Pay. You indicated that you are not receiving Social Security. Pension

You indicated that you do not have any type of pension, 401k, or retirement plan. Able and Available Summary

I am able to search for and accept a full-time job. Union Hiring Hall Summary

You indicated that you are not a member of a union hiring hall. State and Federal Taxes Summary

You indicated that you would like your state and federal taxes to be deducted from your weekly benefit amount. Statistical Info Summary

What is the primary type of occupation you are looking for? delivery driver What is the secondary type of occupation you are looking for? ware house Occupation Selected from List: Light Truck Drivers If you were offered a full-time job today, what is the lowest rate of pay that you would be willing to accept? $18.00

How many dependents do you have? 0

Are you currently in the State of Indiana? Yes

I affirm under the penalties of perjury that the answers I provided above are true and accurate. Signature: Andrew halbert

Claim Confirmation Number: 116136238

(3)

Benefit Rights Agreement

Under 18 U.S.C. §1001, knowingly and willfully concealing a material fact by any trick, scheme, or device or knowingly making a false statement in connection with this claim is a Federal Offence, punishable by a fine or imprisonment for not more than five years, or both, under Title 18 of the United States Code. I understand that I must report all earnings from employment or self-employment regardless of source, including:

- regular payroll

- part-time employment

- temporary employment

- payments made in cash

- payments made by some other method (room and board, trading labor, being given a material item) Initials: AH

I understand that, if I worked during a week in which I claimed benefits, I must report that work and the gross amount of the earnings I have or will receive at some future date for that work on the voucher for the week that the work was performed, regardless of when the earnings will be paid to me. For example, Jane works part-time during the first week of October. Jane will not be paid for her work during the first week of October until sometime in November. Jane claims benefits for the first week of October. Jane must report her part-time work and the gross amount of her earnings for that work on the voucher that corresponds to the first week of October. Initials: AH

I understand that it is prohibited for me to work during one pay period and delay the receipt of payment for that work until a later date when I am not claiming unemployment insurance benefits. For example, John works during the first week of October. John claims unemployment insurance benefits for the first week of October. John delays payment for his work during the first week of October until sometime in November. John has engaged in conduct known as “banking hours”, which is prohibited while claiming unemployment insurance benefits.

Initials: AH

Each week that I claim unemployment benefits, I must advise the Indiana Department of Workforce Development (DWD) if I am engaged in any self-employment activities. I understand that such self-employment may affect my eligibility even though I may not have direct earnings.

Initials: AH

I am responsible for protecting my password and not giving it to anyone. If I give my password to another person and benefits are claimed, I will be held responsible.

Initials: AH

I understand that I must be physically and mentally able to work full-time, available for full-time work, and actively seeking full- time work in order to be eligible for unemployment benefits. If I have been granted a work search waiver by DWD, I do not have to seek other work, but I still must be able to work and available for work. I cannot be incarcerated or hospitalized and be eligible for unemployment benefits.

Initials: AH

I understand that I am required to read the Claimant Handbook, which is available at this link: www.in.gov/dwd/files/Claimant_Handbook.pdf

I understand that I am required to follow instructions in the Claimant Handbook. Initials: AH

I am aware that if I knowingly make any false statements or fail to provide required information, this could be considered as fraudulent behavior. If detected, this would require repayment of my unemployment benefits, will cause penalty and interest to be added to the overpaid amount, will cause elimination of wages for future use in receiving unemployment benefits, and may lead to civil and/or criminal prosecution.

Initials: AH

Claim Confirmation Number: 116136238

(4)

Claim Filing Checklist:

In order to expedite the processing of your claim complete the following next steps as quickly as possible. Make or Change Your Payment Election

You can choose to receive your UI benefits through direct deposit to a U.S. checking or savings account, or on a new Key2Benefits prepaid MasterCard. Visit the profile maintenance section of CSS to get started. Making An Effort To Secure Full-Time Work

In order to be eligible for unemployment benefits, you must make an effort to secure full-time work in each week you claim benefits.

To learn more about activities that count towards your work search requirement visit unemployment.in.gov.

Contact this candidate