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Resume:
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: CASE-000*******
Most Recent Employment
Most Recent Employment
Most Recent Employer Name: Recent Employer Address: Recent Employer Phone
Number:
First Day Worked with Most
Recent Employer:
Last Day Physically Worked
with Most Recent Employer:
Date of Separation From Most
Recent Employer:
What was your rate of pay?: What was the type of pay?: What kind of work did you do?:
What were your regular days
and hours of work each week?:
Reason for Separation:
Separation Details
When you filed or re-opened your unemployment claim, you indicated that you were separated from the employer(s) listed below. Please answer the questions regarding your leave/discharge. Click to answer questions relating to each employer. A new window will appear - click Continue to proceed through sections regarding a single employer. Once you have answered all questions for all employers, click the Next button at the very bottom of the page. Employer Name Status
Claimant Form :: Page 2 of 3
ARCHITECTURAL WINDOW MANUFACTURING
This box will automatically check when the questions regarding your discharge from the employer(s) above have been answered and submitted.:
Discharge from Employer(s)
When you filed or re-opened your unemployment claim, you indicated that you were discharged from the employer(s) listed below. Please answer the questions regarding your discharge. Click Continue to proceed to each new section of questions regarding a single employer. Once you've answered all questions for all employers, click the Next button at the very bottom of the page. Date of Claim
6/16/2024
This box will automatically check when the questions regarding all employers have been completed.:
Document Upload
Please upload any additional documentation that you think will be useful for the Unemployment Agency to make a determination on your Claim.
To Upload Documents:
**Mac Users – If you are unable to attach documents, please use Chrome, Firefox or Edge browsers to complete this process. Users have experienced challenges uploading any required documents through the Safari browser.** Claimant Form :: Page 3 of 3
STEP 1: Click Choose File and locate the file you want to upload. STEP 2: After selecting the file, click the Upload Document button below. STEP 3: Once you see the file name in the action box, click Next . If you do not see your file name under the Action box, then you did not attach the file correctly, please review STEPS 1-3.
Document Name Update Date/Time
Certify & Submit
I certify that my answers are true and accurate to the best of my knowledge and that I am aware the law provides for penalties for false statements.:
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