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Section B2 – Your Work History with the Employer

If you have worked for the employer, complete this section.

If you have no work history with the employer, please leave this section blank. You may have no work history with the employer in cases where you were charged a prohibited fee by a temporary help agency, but you never actually worked for the temporary help agency.

What was your job title? What kind of work did you do?

Write your job title and describe in a few words, the kind of work you did for this employer.

Examples:

  • Title: “Building Superintendent – I fixed and repaired things around the building.”
  • Title: “Temporary help agency assignment employee – I performed administrative work.”

Do you have a record of your hours of work? (e.g. in a diary or calendar)

A record of your hours of work can include anything that is in writing that shows the hours you worked. For example, you may have noted the hours you worked in a diary or calendar, or you may have kept printouts of your work schedule from your employer.

You may be asked to send in photocopies of your record of hours during an investigation of your claim.

  • Please put a check mark () in the “Yes” box if you have a record of your hours of work.
  • Please put a check mark () in the “No” box if you do not have any record of your hours of work.

Did you work the same number of hours each day?

If your hours of work changed from day to day or from week to week, please put a check mark () in the "No" box, and explain why your hours were not regular.

Examples:

  • “Temporary help agency employee – hours changed depending on the client I worked for.”
  • “Receptionist – Monday to Wednesday 8 hours a day, Thursday and Friday 4 hours a day.”
  • “My hours per day and per week vary but I always work 40 hours a week.”

If you worked the same number of hours of each day, please put a check mark () in the "Yes" box, and answer the three following questions (outlined on the Claim Form in bold):

How many hours did you work each day?

Tell us how many hours you worked each day. For example, “8 hours.”

How many days did you work each week?

Tell us how many days you worked in each week. For example, “5 days.”

Total number of hours worked each week

Tell us the total number of hours you worked in each week. To figure out this number, multiply the number of hours you worked in each day by the number of days you worked each week. For example, “40 hours” (8 hours x 5 days).

Pay Period

Did the employer pay you every week, every two weeks, twice every month, once every month, or some other period?

  • Please put a check mark () in the “Weekly” box if you get paid every week.
  • Please put a check mark () in the “Every two weeks” box if you get paid every other week. In this case, you would get 26 pay periods a year.
  • Please put a check mark () in the “Twice a month” box if you get paid only twice a month. For example, you might be paid on the 1st and 14th of each month. In this case, you would get 24 pay periods a year.
  • Please put a check mark () in the “Once a month” box if you get paid only one time in each month.
  • If you put a check mark () in the “Other” box, please tell us how you get paid.

How were you paid?

Please tell us how you were paid.

  • Per hour: Put a check mark () in the “Per hour” box if you were paid the same amount of money for each hour that you worked.
  • Salary: Put a check mark () in the “Salary” box if you were usually paid the same amount of money for every pay period (for example, every week or every two weeks), even if the number of hours that you worked may have varied.
  • Commission: Put a check mark () in the “Commission” box if you were paid a percentage of each sale that you made.
  • Piecework: Put a check mark () in the “Piecework” box if you were paid for each piece of work you completed. For example, by the number of pieces of material that you cut or number of pages typed.
  • Other: If you put a check mark () in the “Other” box, please tell us how you were paid. For example, “Hourly wage plus commission”

Rate of pay before deductions (choose one)

What was your regular pay before taxes? Do not include in this amount any overtime pay that you may also have earned.

When did you start working for this employer?

Enter the date when you started employment with the employer. If you cannot remember the exact day, enter the month and year that you started working for the employer. Note: Even if you began a period of training on the first day of employment, you should count that day as your first day of employment.

Current status*

  • Put a check mark () in the “Still working” box if you are still employed by the employer.
  • Put a check mark () in the “Fired” box if you had your employment terminated or were “let go”, “downsized”, dismissed or discharged.
  • Put a check mark () in the “Laid off” box if the employer suspended, cut back or stopped your work without permanently firing or dismissing you. For example, when there is not enough work, the employer might temporarily “lay off” employees.
  • Put a check mark () in the “Quit” box if you quit your job.
  • If you put a check mark () in the “Other” box, please explain.

Last day you worked for this employer? (yyyy/mm/dd)

Enter the date when you last worked for the employer. If you cannot remember the exact day, enter the month and year that you last worked for the employer.

Did you receive notice of termination before the last day of work?

Were you told before your last day on the job that you were going to be fired or let go? If “yes,” put a check mark () in the “Yes” box. If “no,” put a check mark () in the “No” box.

If you are still working for the employer, please put a check mark () in the “Not Applicable” box.

Date notice of termination was received

If you were told that your employment was going to be terminated or you were going to be laid-off before your last day on the job, please state the date when you were told. If you are still working for the employer, please write “not applicable” or “n/a”.

The notice was "written" or "oral"

How was the notice of termination given to you?

  • Put a check mark () in the “written” box if you were you given this information in writing (written)
  • Put a check mark () in the “oral” box if the employer gave you the notice by speaking to you
  • Put a check mark () in the “I don’t know” box if you are unsure how you got the notice
  • Put a check mark () in the “N/A” box if you did not get notice or if you are still working for the employer

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