Form Teuc202a - Temporary Extended Unemployment Compensation Page 2
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210. List any additional employer in the last 6 weeks.
Reason for Separation:
Lack of Work
Quit
Fired
Strike/Lockout
(Explain)
Still Working
(Business Name)
Last Employer Name
Medical
Leave of Absence
Mailing Address
Phone: (
)
If this is Federal (UCFE) Employment:
Fax: (
)
(d) Position Title:
(e) Part Time/Seasonal:
Yes
No
City, State, Zip
(Starting and End Dates)
Last Employed
(Duty Sta ion, City, Sta e)
t
t
(f)
Place of Employment:
Start:
End:
11. List any additional employer in the last 6 weeks.
Reason for Separation:
Lack of Work
Quit
Fired
Strike/Lockout
(Explain)
Still Working
(Business Name)
Last Employer Name
Medical
Leave of Absence
Mailing Address
Phone: (
)
If this is Federal (UCFE) Employment:
Fax: (
)
(g) Position Title:
(h) Part Time/Seasonal:
Yes
No
City, State, Zip
(Starting and End Dates)
Last Employed
(Duty Sta ion, City, Sta e)
t
t
(i)
Place of Employment:
Start:
End:
12. Out of state or federal employment since March 15, 2001
Reason for Separation:
Lack of Work
Quit
Fired
Strike/Lockout
(Explain)
Still Working
(Business Name)
Last Employer Name
Medical
Leave of Absence
Mailing Address
Phone: (
)
If this is Federal (UCFE) Employment:
Fax: (
)
(j)
Position Title:
(k) Part Time/Seasonal:
Yes
No
City, State, Zip
(Starting and End Dates)
Last Employed
(Duty Sta ion, City, Sta e)
t
t
(l)
Place of Employment:
Start:
End:
13. Are you, or will you receive payment representing:
Sick or Vacation Pay?
Yes
No
If “Yes,” Gross Amount:
$
Employer received from:
Severance or Separation Pay?
Yes
No
If “Yes,” Gross Amount:
$
Employer received from:
Pension/Retirement/Disability Pay?
Yes
No
If “Yes,” Gross Amount:
$
Page 2 of 2
03/15/2002 Form:TEUC202A
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Parent category: Legal