You must complete the Employer Detail section of this screen whether or not the employer infomation at the top automatically fills. In the first field, enter your start date using the format mm/dd/yyyy. Enter your last day worked for this employer in the next field using the same format. If you are a maritime employee, enter the name of the vessel on which you worked in the space provided. Select the county where you worked from the following drop-down box. Enter the employer phone number, including area code.

In the "Reason for Separation”field, select the category that most closely matches the reason for your separation from this employment. Select the detailed reason for separation from the following drop­down box. A Lack of Work separation defaults to Lack of Work as the detailed reason.

Discharge– fired, terminated, dishonorable discharge

Disciplinary Layoff–suspension due to disciplinary action

Lack of Work– layoff, plant shutdown, company closed or out of business, assignment ended, no work available, budget cuts, position eliminated, reduction in workforce

Leave of Absence– medical leave, leave for personal reasons (expected to return to work at end of leave)

Mutual Agreement– neither party initiated the separation

Quit– Voluntarily left employment, could have remained employed but chose to leave

Retirement– voluntary retirement, retired per company agreement, mandatory retirement

Still Employed– Reduced Hours while still working each week or working a permanent part-time schedule

Strike/lockout (labor dispute) – organized lockout, strike or labor dispute at your place of employment

Voluntary Sep/Buyout– Company downsizing, buyout payment or severance package included


Wrong Employer (Internal Staff Use Only)

Select "Yes" if you have worked for this employer in at least six different calendar weeks and earned at least the amount indicated in gross wages; otherwise, answer "No". If you answer "Yes", indicate whether you also worked a second job during your most recent six weeks with this primary employer. Answer "No" if you did not work for another employer during this same time period.