Confirmation — Application Submitted https://uio.edd.ca.gov/UIO/Pages/Public/NewClaim/NewClaimConfirmation.

aspx

Confirmation — Application Submitted

You Successfully Submitted Your Application
Louie Valentine, you submitted an application for unemployment benefits on October 21, 2022. Your confirmation number is 40030247. Keep
this number for your records.

We are currently processing applications and will contact you if we need any additional information within the next few weeks. Meanwhile, visit
After You Apply for important steps you must take to make sure your benefit payments are not delayed or denied.

Important Next Steps

Visit After You Apply to learn about important steps you must take to be eligible for benefits, such as:

!"Looking for important documents from the EDD. Once your application is processed, we will mail documents to you with information
about your claim.
#"Notice of Unemployment Insurance Claim Filed (DE 1101CLMT) (PDF)
#"Notice of Unemployment Insurance Award(DE 429Z) (PDF)
#"Employment Development Department Customer Account Number Notification (DE 5614) (PDF)
#"Unemployment Insurance Benefits: What You Need to Know (DE 1275B) (PDF)
#"Continued Claim (DE 4581) (PDF)

!"Certifying for benefits every two weeks. You must certify to receive benefits. Use UI Online to quickly tell us if you are still unemployed.
You can also access your claim history, view your payment history, request tax forms, and check your inbox.
!"Registering for CalJOBSSM. Use CalJOBS to search for jobs, build résumés, access career resources, and gather information on education
and training programs.

We recommend you bookmark the After You Apply page for later reference.

Canceling a UI Claim
To cancel a claim, do not certify for benefits.

You can only cancel a claim if you meet all of the following requirements:

!"Benefits have not been paid.

!"You haven’t been issued a written notice of disqualification.
!"There is no overpayment from a previous claim.
!"The benefit year of your claim has not ended.

Once a claim is canceled, you cannot submit an application for a new claim using the same beginning date.

Applicant Information

First Name
Louie

Middle Initial
T

Last Name
Valentine

Social Security number (SSN)

XXX-XX-9279

Date of Birth
12/17/1984

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1. Gender
Male

2. If you have used any other names, list them.

Contact Information
1. What is your mailing address?

Location
United States

Number, Street, and Apartment/Unit or PO Box Number

3135 Roadrunner Rd

City
San Marcos

State
CA - California

ZIP Code
92078

2. Is your residence address the same as your mailing address?

Yes

3. If you do not live in California, select the name of the county or county-equivalent (for example, parish, borough,
census area, independent city, etc.) where you live.
San Diego County, CA

4. Phone Number
7602249124

4a. Phone Type

Cell Phone

Citizenship Information
1. Are you a U.S. citizen or national?
Yes

Statistical Information
1. Education
High School Diploma/GED

2. Are you a veteran?

No

3. What race or ethnic group do you identify with?

I Choose Not to Answer

4. Do you have a disability?

No

5. What is your preferred spoken language?

English

6. What is your preferred written language?

English

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Last Employer

Employer Name Employer Mailing Address Employer Physical Address

Mojica and Sons 1031 Oriole Way 1031 Oriole Way

San Marcos, CA 92078 San Marcos, CA 92078
Phone Number: 7603145096 Phone Number: 7603145096

Last Employer Information

1. What is the first and last name of your immediate supervisor?
George Mojica II

2. Last Date Worked

05/13/2022

3. Reason No Longer Working

Important: Your last employer will be contacted to verify the reason you are no longer working. Providing false information is considered
fraud and may result in penalties.

Separation Category
Laid Off/No Work

Separation Explanation
Business closed/Plant shutdown (temporarily or permanently)

4. If you received, or if you expect to receive, any payments from your very last employer or any other employer other
than your regular wages, report the payment below.

4a. Holiday Pay

4b. Vacation Pay

4c. Severance Pay

4d. In-Lieu-Of-Notice Pay

4e. Other Pay

Add Employment Information

1. Did you work for any employer from 07/01/2021 to 09/30/2022?

Yes

If Yes, select the Add Employer button and add the employer details for each employer you've worked for.

Employer Name

Mojica and Sons

1. Employer Information

Employer Name
Mojica and Sons

Mailing Address
1031 Oriole Way

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City
San Marcos

State
ca

ZIP Code
92078

2. First day you worked for this employer?

03/10/2021

3. Last day you worked for this employer?

05/13/2022

4. Did you work as an elected official or Governor appointee for the employer listed above?
No

5. Did you work full time or part time?

Full Time

6. How much did you earn per hour?

$30.00

7. On average how many hours did you work per week?

40

8. Provide wages earned from the employer listed above for the following quarters

Gross wages earned from 10/01/2022 to 12/31/2022

Gross wages earned from 07/01/2022 to 09/30/2022

Gross wages earned from 04/01/2022 to 06/30/2022

$7,200.00

Gross wages earned from 01/01/2022 to 03/31/2022

$15,600.00

Gross wages earned from 10/01/2021 to 12/31/2021

$15,600.00

Gross wages earned from 07/01/2021 to 09/30/2021

$15,600.00

Employment History
1. From 07/01/2021 to 09/30/2022, did you work for any other employers not listed above?
No

2. From 07/01/2021 to today, which employer did you work for the longest?
Mojica and Sons

2a. How long did you work for that employer?

Years
1

Months
2

2b. Select the industry that best describes this employer.

Private Employer

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2c. What type of business did that employer operate? (For example: retail furniture sales, legal services, software
manufacturing, road construction, etc.)
Construction - Special Trade Contractors

2d.What kind of work did you do for that employer?

CASUAL LABORER

School Employee Information

1. Did you work for or provide services to or on behalf of any educational institution between 07/01/2021 to today?
No

Availability Information
1. What type of work do you normally perform?
CASUAL LABORER

2. What other type of work can you perform?

LABORER, GOLF COURSE

3. Is the type of work you normally perform seasonal?

No

4. Do you expect to return to work for a former employer?

No

5. Do you have a date to start work?

No

6. Are you ready and willing to accept work that matches your work skills and educational background? (Example: If
offered a job, would you be able to accept it?)
Yes

7. Are you currently self-employed (have your own business or work as an independent contractor) or plan to become
self-employed?
No

8. Are you a member of a union or a non-union trade association?

No

Additional Information
1. Are you receiving, or will you receive within the next two weeks, a pension or retirement that is not Social Security
or Railroad Retirement, which is based on your own work or wages?
No

2. Are you receiving or do you expect to receive workers' compensation?

No

3. Are you currently attending or have a scheduled start date to attend school or training?
No

4. Are you now or have you been in the last 18 months an officer of a corporation, officer of a union, or the sole or major
stockholder of a corporation?
No

Disaster Information

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1. Are you unemployed as a direct result of a recent disaster (for example: earthquake, flood, mudslide, or fire) in
California?
No

Rate Your Experience

Complete the optional survey below to tell us about your UI Online experience. Your feedback will help us make future improvements.

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2. Provide a brief explanation describing why you chose the experience rating above. (Optional. 250 character
limit)
Do not enter questions or comments about your UI claim or benefits. If you have questions or comments,
Contact the EDD.

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