North Carolina Department of Commerce

Division of Employment Security

Unemployment Insurance 24943784

Help us prevent UI Fraud by responding timely and accurately to requests for information NC CLM 550_68.0.0

WAGE TRANSCRIPT AND MONETARY DETERMINATION

JONATHAN B BLEVINS

5147 PONDEROSA DR

CONOVER, NC 28613-8736

Mail Date: March 29, 2021

Claimant ID: 10955835

Program: UI

This is a statement of your wage credits and a monetary determination of your unemployment insurance benefit rights under Chapter 96 of North Carolina Law.

***This document is an explanation of potential benefits. It is not a guarantee that you will receive unemployment benefits

Base Period Is From: 10/01/2019 Through: 09/30/2020 Employer

Account No.

Employer Name QTR1

4/2019

QTR2

1/2020

QTR3

2/2020

QTR4

3/2020

9018860 MCCREARY MODERN INC $2,603.03 $0.00 $0.00 $0.00 2518167 KING HICKORY FURNITURE CO INC $6,976.44 $10,163.38 $9,950.00 $10,863.89 Seasonal Wages Non-Seasonal Wages Total Wages QTR1 Total QTR2 Total QTR3 Total QTR4 Total

$0.00 $40,556.74 $40,556.74 $9,579.47 $10,163.38 $9,950.00 $10,863.89 Benefit Year Weekly Benefit No. of Maximum Earnings Begins: Ends: Amount Weeks Benefit Amount Allowance 03/28/2021 03/26/2022 $350.00 16 $5,600.00 $70.00

If you feel this determination is incorrect, you may protest within ten days from the mailing of this determination. You may file your protest online at des.nc.gov, or mail/fax to the address below. Please return this form, or a copy with explanation and proof of wages. Continue to file your weekly certifications while your protest is being investigated.

Mail/Fax Protest to:

Post Office Box 27967

Raleigh, NC 27611-7967

Fax Number: 919-***-****

If you did not file a claim for unemployment benefits, this notice may be the result of a fraudulent claim in your name. Please report suspected fraud through the DES fraud hotline at 984-***-**** or the fraud reporting form at https://des.nc.gov/report-unemployment-fraud.

Accessibility and Nondiscrimination Notice

● IMPORTANT! This document(s) contains important information about your unemployment compensation. Call 1-888-***-**** or visit our website at des.nc.gov for free translation assistance. This document may contain important information about your Benefits or Appeal Rights that may require your response for appealing decisions within 10 days for lower authority and 30 days for higher and judicial authorities.

● IMPORTANTE! Este(os) documento(s) contiene(n) información importante sobre su compensación por desempleo. Llame al 1-888-***-**** o visite nuestro sitio web en des.nc.gov para obtener asistencia gratuita con la traducción. Este documento puede contener información importante sobre sus beneficios o su derecho de apelación, la cual podría requerir su respuesta para las decisiones de apelación en un plazo de 10 días para las autoridades de menor nivel y de 30 días para las autoridades de mayor nivel y judiciales.

●

1-888-***-**** des.nc.gov

● QUAN TRỌNG! Các) tài liệu này chứa thông tin quan trọng về tiền bồi thường thất nghiệp của bạn. Hãy gọi tới số 1-888-***-**** hoặc truy cập trang web theo địa chỉ des.nc.gov để được trợ giúp dịch thuật miễn phí. Tài liệu này có thể chứa thông tin quan trọng về các Phúc Lợi hoặc Quyền Khiếu Nại của bạn, có thể yêu cầu bạn phải trả lời nếu muốn khiếu nại quyết định trong vòng 10 ngày đối với cơ quan có thẩm quyền cấp dưới và 30 ngày đối với cơ quan có thẩm quyền cấp trên và cơ quan tư pháp.

● IMPORTANT ! Ce(s) document(s) contient/contiennent des informations importantes concernant votre allocation de chômage. Téléphonez au 1-888-***-**** ou rendez-vous sur notre site Web à des.nc.gov pour obtenir gratuitement de l'aide en traduction. Ce document peut contenir des informations importantes sur vos allocations ou sur votre droit de faire appel, qui peuvent, en cas de décisions d'appel, nécessiter votre réponse dans les 10 jours pour les autorités administratives de niveau inférieur et dans les 30 jours pour les autorités judiciaires et les autorités administratives de niveau supérieur. Equal Opportunity Is the Law

It is against the law for this recipient of Federal financial assistance to discriminate on the following bases: Against any individual in the United States, on the basis of race, color, religion, sex (including pregnancy, childbirth, and related medical conditions, sex stereotyping, transgender status, and gender identity), national origin (including limited English proficiency), age, disability, or political affiliation or belief, or, against any beneficiary of, applicant to, or participant in programs financially assisted under Title I of the Workforce Innovation and Opportunity Act, on the basis of the individual's citizenship status or participation in any WIOA Title I-financially assisted program or activity. The recipient must not discriminate in any of the following areas: Deciding who will be admitted, or have access, to any WIOA Title I-financially assisted program or activity; providing opportunities in, or treating any person with regard to, such a program or activity; or making employment decisions in the administration of, or in connection with, such a program or activity. Recipients of federal financial assistance must take reasonable steps to ensure that communications with individuals with disabilities are as effective as communications with others. This means that, upon request and at no cost to the individual, recipients are required to provide appropriate auxiliary aids and services to qualified individuals with disabilities. What To Do If You Believe You Have Experienced Discrimination If you think that you have been subjected to discrimination under a WIOA Title I-financially assisted program or activity, you may file a complaint within 180 days from the date of the alleged violation with either: The recipient's Equal Opportunity Officer (or the person whom the recipient has designated for this purpose); or The Director, Civil Rights Center (CRC), U.S. Department of Labor, 200 Constitution Avenue NW., Room N-4123, Washington, DC 20210 or electronically as directed on the CRC Web site at www.dol.gov/crc. If you file your complaint with the recipient, you must wait either until the recipient issues a written Notice of Final Action, or until 90 days have passed (whichever is sooner), before filing with the Civil Rights Center (see address above). If the recipient does not give you a written Notice of Final Action within 90 days of the day on which you filed your complaint, you may file a complaint with CRC before receiving that Notice. However, you must file your CRC complaint within 30 days of the 90 day deadline (in other words within 120 days after the day on which you filed your complaint with the recipient). If the recipient does give you a written Notice of Final Action on your complaint, but you are dissatisfied with the decision or resolution, you may file a complaint with CRC. You must file your CRC complaint within 30 days of the date on which you received the Notice of Final Action. Auxiliary aids and services for individuals with disabilities: We provide free auxiliary aids and services to people with disabilities to communicate effectively with us such as: Qualified American Sign Language (ASL) interpreters and written information in other formats (large print, audio, accessible electronic formats, other formats). If you need these services, or would like more information about these services, please contact our Interpreter Services at 1-888-***-**** (voice/TTY) or contact North Carolina’s TTY Relay Service at 800-***-**** or 711

(http://www.relaync.com/tty).

Language Access: We also provide free language services to people whose primary language is not English including qualified interpreters and information translated in other languages. If you need these services, or would like more information about these services, please contact our Interpreter Services at 1-888-***-****.

If you believe our agency has failed to provide the aforementioned services to you or discriminated against you, you can file a complaint by contacting our Legal Services Section using the following methods: by email: ad2pm2@r.postjobfree.com; or by mail: Legal Services Section, Post Office Box 25903, Raleigh, NC 27611-5903. Important Information About Receiving Unemployment Benefits To receive unemployment benefits, you are required to 1) register for work, 2) complete work search requirements and 3) file a weekly certification for each week of benefits. 1. REGISTER FOR WORK: All individuals filling for unemployment insurance must be registered with their local job service office. For North Carolina residents, register by going to www.ncworks.gov and creating an account. Click on the ‘Sign In’ link in the top right corner and the website will guide you through the steps to complete your account registration. If you fail to register for work at www.ncworks.gov by setting up an NCWorks online account, your benefits will be delayed or denied.

*Claimants from outside of North Carolina should register with their state’s Job Service Office/Career Center.

2. WORK SEARCH: To receive unemployment benefits, you must make contact with three different employers each week and maintain documentation of your work search. Due to COVID-19, you may temporarily satisfy up to two of the three employer contacts by participating in reemployment activities

(ex. workshops, self-assessments, career fairs) offered by your local NCWorks Career Center and/or their partner agencies. See the Work Search Guidelines for details about completing and documenting your work search activities.

3. WEEKLY CERTIFICATION: Once you have filed a claim for unemployment insurance benefits, you must file a weekly certification for each week you wish to claim benefits. Completion of your weekly certification is what initiates your benefit payment. If you do not complete your weekly certification within 14 days after the end of a benefit week, you WILL NOT receive payment for that week.

File your weekly certifications even if a decision of eligibility has not been made on your claim. File your weekly certification through your online account at des.nc.gov or contact the DES Customer Call Center for assistance.

CLAIMANT SELF-SERVICE PORTAL: Remember to check your DES online account for more important information! Access your claimant self-service portal through your DES online account on a regular basis. The portal provides important information about your claim such as status, payments, benefit balances, documents and information needed to process your claim. You may also update a change of address, your tax withholding or bank information, and complete your weekly certifications. Visit des.nc.gov to learn more or contact the DES Customer Call Center at: 1-888-***-****

ad2pm2@r.postjobfree.com

North Carolina Department of Commerce

Division of Employment Security

Unemployment Insurance 24943784

Help us prevent UI Fraud by responding timely and accurately to requests for information NC CLM 550_29.0.0

Work Search Record

Claimant JONATHAN B BLEVINS

Claimant ID 10955835

Review Date

Interviewer

Work Search Requirements: Employment Security Law N.C.G.S. 96-14.9(e) requires you to be registered for work (www.ncworks.gov) and actively seeking work with a minimum of three contacts with potential employers for each week you claim unemployment benefits. Due to COVID-19, you may temporarily satisfy up to two of the three employer contacts by participating in reemployment activities (ex. workshops, self-assessments, career fairs) offered by your local NCWorks Career Center and/or their partner agencies. You must keep a detailed record of all your work search activities, which are subject to audit by DES. You should maintain these records for at least five years. Failure to maintain an adequate and verifiable work search record for any week claimed may result in a denial, delay, and/or overpayment of benefits. For instructions on how to make a valid contact, please review the Work Search Guidelines included with this form. WEEK _ Beginning Sunday And Ending Saturday

Contact Method Provide name of contact (if

applicable) AND one (1) of the

following based on contact

method:

Date of Contact

or

Activity

Company Contacted

or

Reemployment

Activity Attended

In Person (I)

Telephone (T)

*Email (E)

*Online (O)

Fax (F)

Physical Address

Telephone Number

Email Address

Website Address

Fax Number

Position Seeking Results

(Ex. Not Hiring,

Submitted

Application,

Interview,

Second Interview,

Submitted Resume,

Activity Completed)

*Attach a copy of confirmation email or confirmation number for any online contacts. WEEK _ Beginning Sunday And Ending Saturday

Contact Method Provide name of contact (if

applicable) AND one (1) of the

following based on contact

method:

Date of Contact

or

Activity

Company Contacted

or

Reemployment

Activity Attended

In Person (I)

Telephone (T)

*Email (E)

*Online (O)

Fax (F)

Physical Address

Telephone Number

Email Address

Website Address

Fax Number

Position Seeking Results

(Ex. Not Hiring,

Submitted

Application,

Interview,

Second Interview,

Submitted Resume,

Activity Completed)

*Attach a copy of confirmation email or confirmation number for any online contacts. North Carolina Department of Commerce

Division of Employment Security

Unemployment Insurance 24943784

NC CLM 550_29.0.0 Page 2 of 2

WEEK _ Beginning Sunday And Ending Saturday

Contact Method Provide name of contact (if

applicable) AND one (1) of the

following based on contact

method:

Date of Contact

or

Activity

Company Contacted

or

Reemployment

Activity Attended

In Person (I)

Telephone (T)

*Email (E)

*Online (O)

Fax (F)

Physical Address

Telephone Number

Email Address

Website Address

Fax Number

Position Seeking Results

(Ex. Not Hiring,

Submitted

Application, Interview,

Second Interview,

Submitted Resume,

Activity Completed)

*Attach a copy of confirmation email or confirmation number for any online contacts. WEEK _ Beginning Sunday And Ending Saturday

Contact Method Provide name of contact (if

applicable) AND one (1) of the

following based on contact

method:

Date of

Contact

or

Activity

Company Contacted

or

Reemployment

Activity Attended

In Person (I)

Telephone (T)

*Email (E)

*Online (O)

Fax (F)

Physical Address

Telephone Number

Email Address

Website Address

Fax Number

Position Seeking Results

(Ex. Not Hiring,

Submitted

Application, Interview,

Second Interview,

Submitted Resume,

Activity Completed)

*Attach a copy of confirmation email or confirmation number for any online contacts. I do solemnly affirm under penalty of perjury, that I am the person named herein, and that the information that I have provided, including proof of identification and the work search record, is true, correct, and complete to the best of my knowledge. I further understand that there are severe criminal and civil penalties for providing false statements and/or willfully misrepresenting any information to increase or receive unemployment insurance benefits, and that any information I have provided is subject to verification.

Claimant's Signature: Date: Work Search Guidelines

To receive unemployment benefits, you must make contact with three different employers each week and keep a record of your work search. Due to COVID-19, you may temporarily satisfy up to two of the three employer contacts by participating in reemployment activities (ex. workshops, self-assessments, career fairs) offered by your local NCWorks Career Center and/or their partner agencies.

What can I do to fulfill my work search requirements each week?

• Contact employers who have a position matching your qualifications, knowledge, abilities or skills. Employer contact must be for the purpose of obtaining employment.

• Participate in approved and verified reemployment activities. May count for no more than two of the three required contacts each week.

What are acceptable methods of contacting employers?

• Submitting an application, resume, letter of interest, etc., through the employer or an employment website, such as NCWorks.

• Having a telephone conversation with an employer. Note: Leaving a message or voicemail is not sufficient

• Attending a meeting with the employer. May include contact at job fairs or similar events or video interviews.

• Registering with NCWorks.gov. Can only be used as a contact for the week registration was completed.

• Responding to a blind job advertisement (an online or newspaper ad that does not give the company name). A copy of a blind advertisement may substitute for employer name, name of contact and job title. You must keep a copy of the advertisement for your records.

What kinds of reemployment activities may count as work search contacts?

• Skill Set Courses (Provided by NCWorks Career Centers and/or Partner Agencies)

• Workshops (ex. Resume Preparation, Interviewing, Social Media Job Searches, Branding)

• Soft Skills Training (Professional or Social Etiquette)

• Industry/Occupational Specific Training (ex. CPR)

• Alison Online Training

• GCFLearnFree.org Classes

• English as a Second Language (ESL) Classes

• Literacy Courses (Reading and Financial)

• Online Career Tools (Provided by NCWorks Career Centers and/or Partner Agencies)

• Employment Websites (ex. Indeed)

• NCCareers.org features, such as Reality Check, Interest Profiler, Career Cluster Guide

• Telephone Reemployment Assistance with NCWorks Career Centers and/or Partner Agencies

• Career Counseling (ex. Job Seeking Tips, Interviewing Basics)

• Career Explorer (NCWorks Interest and Skills Assessment)

• Job Skills/Personal Skills/Workplace Skills (Self-Assessments)

• Work Interests/Work Values (Self-Paced Inventories in NCWorks)

• Career Counseling (ex. Job Seeking Tips, Interviewing Basic)

• Job Clubs and/or Networking Groups (NCWorks/Partner/Community-Recognized)

• Resume Preparation, Review and/or Assistance

• Career Fair (Virtual and/or In-Person)

• Job Search/Virtual Recruiter

• Job Referrals

If you have any questions regarding a specific reemployment activity not listed, please contact your local NCWorks Career Center PLEASE SEE REVERSE

Keeping a Record of Your Work Search

You are required to keep a detailed record of your work search activities each week. You will receive a blank Work Search Record form that you can use to document your work search activities. Blank Work Search Record forms can also be downloaded at des.nc.gov. For audit purposes, you must retain these records for five years. Your work search record must include:

• Date of Employer Contact or Reemployment Activity.

• Company Contacted or Reemployment Activity Attended.

• Contact Method.

• Name of Contact (if applicable) and the Website, Email Address, Fax Number, Telephone Number or Physical Address for the contact or activity. (If you are using an employment website, provide the name of the employer you are applying for a position with AND the name of the employment website.)

• Position you are seeking.

• Results

Below is an example of a valid work search record. WEEK 1 Beginning Sunday 7/29/2018 And Ending Saturday 8/4/2018 Contact Method Provide name of contact (if applicable) AND one (1) of the following based on

contact method:

Date of Contact

or

Activity

Company Contacted

or

Reemployment

Activity Attended

In Person (I)

Telephone (T)

*Email (E)

*Online (O)

Fax (F)

Physical Address

Telephone Number

Email Address

Website Address

Fax Number

Position Seeking Results

(Ex. Not Hiring,

Submitted

Application, Interview,

Second Interview,

Submitted Resume,

Activity Completed)

07/31/2018 Al's Plumbing I Alfonso Johnson

123 Main St, Burlington, NC

Plumber Second Interview

08/01/2018 Blind Advertisement E ad2pm2@r.postjobfree.com Copy of Ad Attached

Customer Service

Rep

Resume Submitted by

Emial

08/02/2018 Resume Writing for NCWorks.gov

Professionals

O

Confirmation Email Attached

Online Workshop Activity Completed

*Attach a copy of confirmation email or confirmation number for any online contacts.

Contact this candidate