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

Form De 8686 - Work Sharing (Ws) - Unemployment Insurance Plan Application Page 5

UNION/COLLECTIVE BARGAINING UNIT(S) CONCURRENCE

This page may be duplicated if additional signatures are required

The authorized union representatives certify that they have read and understand the "Certifying Information" on page four and

agree that their membership may participate in the WS program.

Please print or type the following information

Union Name:

Union Local Number:

Telephone Number: (

)

Telephone Number: (

)

Name of Authorized Union Representative

Position Title

Authorized Union Representative Signature

Date:

Please print or type the following information

Union Name:

Union Local Number:

Telephone Number: (

)

Telephone Number: (

)

Name of Authorized Union Representative

Position Title

Authorized Union Representative Signature

Date:

Return this application to:

To order Work Sharing Certifications, DE 4581WS,

call:

(916) 464-3323

Employment Development Department

Special Claims Office

For further information, call the Special Claims Office

P. O. Box 269058

at:

(916) 464-3343 or FAX (916) 464-3333

Sacramento, CA 95826-9058

PAGE FIVE OF FIVE

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

Form De 8686 - Work Sharing (Ws) - Unemployment Insurance Plan Application Page 5