Form De 8686 - Work Sharing (Ws) - Unemployment Insurance Plan Application (Page 2 of 5) in pdf

Form De 8686 - Work Sharing (Ws) - Unemployment Insurance Plan Application Page 2

Enter the estimated weekly percentage reduction in hours and wages of employees participating in the WS plan:

9. Please fill in the blanks (use additional paper if necessary):

A. Work Unit(s) participating in WS

B. Number of employees in unit(s)

C. Number of employees participating in WS

TOTALS:

10. Please enter an "X" in the box next to the appropriate response:

A. Payroll periods are:

Weekly

Bi-Weekly

Monthly

Other (Specify)

B. If pay periods are weekly or bi-weekly, the payroll ending day is:

Mon

Tues

Wed

Thur

Fri

Sat

Sun

11. Is this WS plan part of a transition to a permanent layoff or closure?

Yes

12. Briefly describe the circumstances requiring your use of the WS program to avoid layoffs:

13. Are any participating employees covered by a union/collective bargaining agreement?

Yes

(If Yes, page 5 must be completed)

14. Your participation in the Work Sharing program is confidential. Occasionally the Employment Development Department receives

requests for the names of companies that would be willing to share their experiences in this program. Are you willing to have

your name released for this purpose?

Yes

15. Please answer the following:

Does your WS plan involve:

A. At least two employees?

Yes

B. At least 10% of your workforce or work unit(s)?

Yes

C. At least a 10% reduction in BOTH hours worked and wages?

Yes

THANK YOU FOR CHOOSING WORK SHARING

PAGE TWO OF FIVE

DE 8686 Rev. 14 (12-03) (INTERNET)

Form De 8686 - Work Sharing (Ws) - Unemployment Insurance Plan Application Page 2