The Unemployment Commission Form is a legal document used to request unemployment benefits. The form must be submitted within certain time limits after the worker becomes unemployed. The purpose of the form is to provide information about the worker's eligibility for unemployment benefits. The Unemployment Commission will use the information on the form to determine whether or not to approve the request for unemployment benefits. There are several sections on the Unemployment Commission Form, including contact information, employment history, wages earned and deductions made, and reason for separation from employment. It is important to complete all sections of the form accurately and honestly. Any false statements may result in denial of unemployment benefits. For more information on how to complete the Unemployment Commission Form, please visit our website.
Below is the information relating to the form you were looking for to fill in. It will show you how much time it sh
Question | Answer |
---|---|
Form Name | Unemployment Commission Form |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | form ncui 551l, nc clm 500ab form printable, form nc clm 500ab, ncu1500ab form |
NC DEPT. OF COMMERCE – DIVISION OF EMPLOYMENT SECURITY
REQUEST FOR SEPARATION INFORMATION FROM EMPLOYER
The individual named below filed a claim for unemployment insurance benefits and listed you as the last employer. Your reply will be considered when determining the individual’s eligibility if it is received by the due date. Failure to provide a timely, legible and detailed response or failure to attend any appeals hearing related to this claim may result in an increase in your tax rate. You may respond by mail or by fax. If your reply is submitted by fax, please do not return the paper form. Please provide an email address or fax number in case additional information is needed. If the individual is unemployed due to “lack of work” or “inability to perform available work,” the separation will not be examined and your account will be subject to charges for any benefits paid to the claimant.
Return To:
Division of Employment Security
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Fax Number: (919) |
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Tel Number : (888) |
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1. |
Date Mailed |
2. Response Due Date |
3. If the claimant is filing an initial claim and you are also a base |
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period employer, you will receive, under separate mailing, Form |
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NCUI 551L Notice of Unemployment Claim, Wages Reported, and |
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Potential Charges. |
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4. |
Claimant Name |
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5. Effective Date of Claim |
6. Social Security Number |
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7. If the claimant did not work for you, check this box. |
EAN: |
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8. Reason why claimant is no |
9. If still employed, please check one of the following boxes. Enter the number of hours |
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longer working: |
worked if applicable. |
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Please check only one box |
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This claimant was hired |
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) hours and now working reduced ( |
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) hours. |
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Temporary Agency (go to Item 14) |
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This claimant has not separated but was hired |
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Quit (complete Item 15) |
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10. First Day Worked |
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11. Last Day Worked (i.e., last |
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12. Rate of Pay |
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Discharge (complete Item 16) |
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day physically worked) |
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Inability to perform the work |
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Lack of Work/Laid Off |
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$ |
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per |
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______ |
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Other (complete Item 17) |
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M |
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13. Did claimant receive: |
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Gross Amount |
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Date Paid |
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Number of |
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Weeks |
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Days |
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Hours |
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a. Regular wages for last week worked? |
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Yes |
No |
$ |
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b. Wages in Lieu of Notice (payment to |
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compensate the employee for no notice or |
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Yes |
No |
$ |
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short notice of layoff)? |
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c. Vacation Pay (report unused vacation)? |
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Yes |
No |
$ |
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d. Severance Pay or Separation Bonus? |
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Compensation for weeks not worked after |
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separation. Each payment impacts the |
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claim differently. |
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Severance Pay? |
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Yes |
No |
$ |
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Separation Bonus? |
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Yes |
No |
$ |
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e. Other Payment(s)? If Yes, for what |
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$ |
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reason did you make the payment? |
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Yes |
No |
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f. Company Pension? |
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Yes |
No |
$ |
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How Paid? |
Lump Sum |
Monthly |
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(office use only) |
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(see other side)
Claimant:SSN:DD:
14. COMPLETE THIS SECTION IF YOU ARE A TEMPORARY EMPLOYMENT SERVICES EMPLOYER:
The individual is not separated, is eligible for suitable work assignments, but no suitable work assignments are currently available.
Was claimant offered a new assignment? |
Yes |
No |
If yes, did he/she accept? |
Yes |
No |
If the questions above do not apply to this claimant, please respond to either Item 15 or 16.
Please provide the following information regarding work refused:
Date offered Type of work |
Pay Rate: $ |
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Days Hours Distance |
Reason |
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HR WK |
MO |
YR |
to site |
refused |
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Go to #17 |
The following questions refer to the claimant’s last assignment:
Employer name and location:
Claimant’s job: |
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First day worked: |
Last day worked: |
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Pay rate: $ |
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Work hours: |
Days worked: |
HR WK |
MO |
YR |
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15.COMPLETE THIS SECTION IF THE CLAIMANT QUIT.
a. What reason did the claimant give for quitting? (If you need more space, continue in Item 17.)
b. Did claimant give prior notification of resignation? |
Yes |
No If yes, please provide date: |
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If claimant gave notification was it: |
Oral |
Written |
(Please provide copy) |
16.COMPLETE THIS SECTION IF THE CLAIMANT WAS DISCHARGED. a. When you informed the claimant of the discharge, what reason did you provide?
Was this a policy violation? ? |
Yes |
No |
If Yes, please provide documented proof as necessary. |
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b. Was the claimant warned regarding this behavior? |
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Yes |
No |
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Date(s) of warnings for this behavior? |
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The warning(s) was: |
Oral |
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Written |
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Both |
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(Provide details regarding the nature of the warnings in Item 17. Attach documentation.) |
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c. Did the reason for discharge involve tardiness or attendance? ? |
Yes |
No If Yes, please provide the dates and reasons |
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regarding incidents. |
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17. COMPLETE THIS SECTION OR A SEPARATE SHEET FOR ADDITIONAL INFORMATION.
Name of the individual to contact for additional information: |
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Contact Telephone Number: |
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( |
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Signature |
Name Printed |
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Title |
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Date Signed |
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Email address: |
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Fax number: ( |
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(Please fax both front and back sides to DES)
NCUI500AB (Revised 06/30/2013)