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Friday, September 18, 2009 Please note: Your application for unemployment insurance has not yet been submitted! To submit it, you must click on the Submit Application button at the bottom of the page. Please review this form for accuracy and completeness. If changes are needed, click the Return to Application button and make any required changes before returning here. After you submit your application, you will receive the Confirmation page which will have a confirmation number. This number is your proof of submission. 1. Social Security Number (SSN) 602 52 **** 1b. Did the Social Security Administration issue this SSN to you? Yes 2. Date of Birth 2/11/1976 3. Gender Female 4. Claimant Name 4a. First Name DER 4b. Middle 4c. Last Name LEE Initial 5. Is this the name that appears on your social security card? Yes 6. If you have used any other Social Security Numbers, please list them 6a. 6b. 7. If you have used any other names, please list them 7a. 7b. 7c. 8. Do you have a state-issued Driver's License or ID card? Yes If Yes: 8a. Name of issuing state CA 8b. Driver's License or ID Number B5329363 9. In the past 2 years did you file a claim for Unemployment Insurance (UI) or Disability Insurance (DI)? No 10. Mailing Address. 10a. Number and Street / P.O. Box and Number 4328 W. AMHERST AVE 10b. City CALIFORNIA 10c. State CA 10d. ZIP Code 93722 11. Is your residence the same as your mailing address? No If No, please provide your residence address. 11a. Number and Street 5466 W. GRIFFTH WAY 11b. City CALIFORNIA 11c. State CA 11d. ZIP Code 93722 12. If you do not live in California, please provide the name of the county or countyequivalent (e.g. parish, borough, census area, independent city, etc.) where you live.
13. Telephone Number (559) 367-8232 13a. Telephone Type Cell phone 14. Preferred spoken language? Hmong 15. Preferred written language? English 16. Education High School 17. Are you a Veteran? No Diploma/GED 18. Ethnic Identification Choose not to 19. Race Asian answer 20. Are you disabled? No 21. Are you a U.S. Citizen or national? No If No: 21a. Are you registered with the United States Citizenship Yes and Immigration Services (USCIS, formerly INS) and authorized to work in the United States? If Yes: 21b. What is the title and number of the USCIS Permanent Resident document you have? Card (I-551) 21c. Alien Registration Number (A#) 072603844 21d. Permanent Resident Card Number 21e. Arrival/Departure Number 21f. Passport Number 21g. Visa Number 21h. Other Document Description 21i. Document Expiration Date 7/14/2014 21j. Were you legally entitled to work in United States Yes for the past 19 months? 22. Are you a member of a union? No 23. Are you receiving, or will you receive in the next year, a No pension other than Social Security or Railroad Retirement, which is based on your own work or wages? 24. Are you receiving or do you expect to receive Workers No Compensation? 25. Information about your very last employer: 25a. Name of Last Employer TELEDYNE KW MICROWAVE 25b. Number and Street / P.O. Box and Number 14020 STOWE DRIVE 25c. City POWAY 25d. State CA 25e. ZIP Code 92064 25f. Telephone Number of Last (858) 842-2922 Employer 25g. What is the full name (first and last) JOR THAO of the person who was your immediate supervisor? 26. Is the location or physical address of your very last employer the same as their mailing address? No If No, please provide the employer's physical address or location. Please note that the
physical address (where the main office or headquarters is located) for many employers may be different than the local office site. 26a. Number and street 5794 E. SHIELDS AVE 26b. City FRESNO 26c. State 26d. ZIP Code 93727 CA 26e. Telephone Number at this (559) 255address 5090 27. Last Date Worked 9/17/2009 27a. What are your gross wages for your last $2,106.01 week of work? 28. Reason No Longer Working Strike or Lockout 28a. Please provide a brief explanation: Reduction in Force 28b. Are you unemployed as a direct result of a No recent disaster in California? 29. Do you expect to return to work for a former No employer? 30. Do you have a date to start work? No 31. Are you an employee of a school, educational No institution, or training facility? 32. If you received, or if you expect to receive, any payments from an employer other than your regular salary, report the payment(s) below. 32a. Holiday Pay Yes Amount From 2/11/2008 To $66.40 9/17/2009 32b. Vacation Pay Yes Amount From 2/11/2008 To $509.95 9/17/2009 32c. Severance Pay Yes Amount From 2/11/2008 To $664.00 9/17/2009 32d. In-Lieu-Of-Notice Pay No Amount From To 32e. Other Pay No Amount From To 32f. Please explain Other Pay, if any: 33. Provide your employment history for the past 18 months, including your very last employer. If you worked for a temporary agency, a labor contractor, an agent for actors, or an employer where wages are reported under a corporate name, your wages may have been reported under that employer name. You may want to refer to your check stub(s) or W-2(s) to obtain the name of your employer. Note: Failure to report all your employers, periods of employment and wages correctly may result in your benefits being delayed or denied. 33b. 33c. Dates of Employment 33d. 33e. Employer Name Beginning Ending Wages How were you (mm/dd/yyyy) (mm/dd/yyyy) Earned Paid?
AMADOR SYSTEMS RABBIT SEMICONDUCTOR TELEDYNE KW MICROWAVE
7/24/1994 4/25/2004 2/11/2008
4/29/2004 8/25/2007 2/17/2009
($) $8.00 $10.35 $8.30
Hourly Hourly Hourly
34. Employer worked for the longest AMADOR SYSTEMS 34a. How long did you work for that employer? Years 11 Months 8 34b. What type of business did that employer PRINTED CIRCUIT BOARD operate? (For example, manufacturing, retail furniture sales, construction,agriculture, etc.) 34c. What kind of work did you do for that SOLDERING employer? 35. During the past 18 months, did you work for any No other employers not listed above in question 33? 36. What is your usual occupation? SOLDER 37. Is your usual occupation seasonal? No 38. Are you currently self-employed (have your own business No or work as an independent contractor) or plan to become self-employed? 39. Are you now or have you been in the last 18 months an No officer of a corporation or union or the sole or major stockholder of a corporation? 40. Are you currently attending or are you planning to attend No school or training? 41. Are you available for immediate full-time work in your Yes usual occupation?
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Friday, September 1
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eApply4UI Submission Confirmation Thank you, Der Lee. You have successfully submitted your eApply4UI Application. Your confirmation number is: 8424629 Please print this page and keep this confirmation number until you receive UI Claim materials by mail. Please allow ten days for your claim to be processed and to receive the UI claim materials. If you have not received any of the UI claim materials after ten days, you should call EDD. Keep the confirmation number as your proof of submission. Important! If you completed apprenticeship training, be sure to mail your training certificate with your Continued Claim Form, DE 4581, for the week(s) of training. CalJOBS is an EDD Internet service that allows you to post your resume for employers to view and look for job openings anywhere in California. Click here to go to CalJOBS .
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