Equipment Operator Drivers

STATED TENNESSEE

DEPARTMENT OF LAB

OWSIONOF

SEPARATION NOTICE

1. Employee's Name; Daniel M Nunley 2. SSN; ***-**-****

Fest fe Initiol oj eee

3. Last Employed: From oer00 10-067****** oeeupaton Gi

inmrddipy Taimraaiypyy

4. where was work performed? “Venhes

gMermvesese eB Ge Win 2950 4/8)

5. Reason for Separation: [XX] Lack of Work LD oischarge Dau

Iflack of work, indicate if layoff is:

Permanent [Temporary-necaloote

ren

If temporary, report any vac h be paid. Week Ending Da

IF layoffs indefinite vacation pay should not be reported

6. Employee received:

82s in Leu of Notice © []

tn the amount of $ for periadlfrom —__

If other th. x

an lack of work, explain the circumstances of this separation:

EE m= OF tt more

a

Employer's Name: Baker's Construction Services

‘Address where additional information may be obtained Employer's Telephone Number:

423-***-****

luff City, TN 37618 [Employers Email Address)

[sero pen ner '

1533 HWY 11 E

Employer's account Number: 02902121

This reser ae Been tiene toor armed to che worker. \

e of Official or Re} ve of the Employ

he ther easons

ti

your response.

NOTICETO EMPLOYEE

YOU MAY BE INSTRUCTED TO MAIL OR FAX THE SEPARATION NOTICE}TO TENNESSEE CLAIMS OPERATIONS IF YOU

FILE A CLAIM FOR UNEMPLOYMENT INSURANCE BENEFITS.

1489 (Rev. 08-4020)

RDA 0063

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