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You need to write down the appropriate data in the Compensation for weeks not worked, Severance Pay Separation Bonus e, Yes, Yes, Yes, f Company Pension, Yes, How Paid, Lump Sum, Monthly, office use only, see other side, and NCUIAB Revised field.
It's essential to note certain particulars inside the area COMPLETE THIS SECTION IF YOU ARE, The individual is not separated is, available, Was claimant offered a new, Yes, If yes did heshe accept, Yes, If the questions above do not, Please provide the following, Type of work, Pay Rate, HR WK, BIWK, The following questions refer to, and Employer name and location.
As part of box b Did claimant give prior, Yes, No If yes please provide date, If claimant gave notification was, Oral, Written Please provide copy, COMPLETE THIS SECTION IF THE, a When you informed the claimant, Was this a policy violation, Yes, No If Yes please provide, b Was the claimant warned, Yes, Dates of warnings for this behavior, and The warnings was Written Provide, specify the rights and responsibilities.
Review the fields Signature, Name Printed, Title, Date Signed, Email address, Fax number, Please fax both front and back, and NCUIAB Revised and thereafter complete them.
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