Sample Notice 3 (Page 2 of 2) in pdf

Sample Notice 3 Page 2

Page 2

Once you are laid off, you are eligible for Unemployment Insurance (UI). You should access the

Employment Development Department (EDD) website to identify how to apply for UI. If you

intend to choose an earlier layoff date (Part III of the Form DPA-015), contact the EDD Office

BEFORE YOU MAKE THE DECISION to see if it will impact your benefits.

You can continue health, dental, and vision coverage for yourself and your dependents for up to

18 months after layoff by applying for COBRA continuation coverage. COBRA is the

abbreviation for Consolidated Omnibus Budget Reconciliation Act, the federal law that allows

individuals to continue participation in their employer’s group plan if they are laid off.

If you elect to be laid off, the Department of Celestial Motorvation will issue you a check for

unused vacation or annual leave and compensating time off to which you are entitled. Any sick

leave will remain in your records and be credited to you if you return to State service while you

are still on a reemployment list.

You may appeal this notice as provided by DPA Rule 599.904, unless otherwise provided by

your collective bargaining agreement.

If you have any questions, please contact [Contact Name], at telephone number [Phone

Number].

Signature

Title

Date

Attachment

NOTES:

SEND THIS NOTICE TO THE EMPLOYEE VIA CERTIFIED MAIL WITH RETURN RECEIPT

REQUESTED. PROOF OF SERVICE SHOULD BE COMPLETED.

(Rev. 10/03)

Sample Notice 3 Page 2