nilpa NC esc

Please review the following information for accuracy. If the information that is displayed is correct, click the 'Submit Claim' button at the bottom of the screen to submit your Unemployment Insurance Benefits Claim.

Citizenship:

*Are you a U.S. citizen?:

Yes No

*Are you authorized to work in the U.S.?:

Yes No

*Alien Registration Number:

9 numbers max., no letters or special characters

An individual who is not a citizen of the U.S. or is not authorized to work in the U.S. is not permitted to file a claim for Unemployment Benefits offered by the Division of Employment Security. If you need further assistance, please contact the DES Customer Call Center at 1-888-737-0259.

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Contact Information:

*First Name:

As listed on your Social Security Card or any legal document

Middle Initial:

*Last Name:

As listed on your Social Security Card or any legal document

Suffix:

JR SR I II III IV V

*Primary Phone:

Alternate Phone:

*Email Address:

Click here if you currently do not have an email address

*Confirm Email:

Please re-type your email address

*Country:

United States Canada

*Mailing Address:

*City:

*State:

Alabama Alaska American Samoa Arizona Arkansas Armed Forces of America Armed Forces of Europe Armed Forces of Pacific California Colorado Connecticut Delaware District Of Columbia Federated States Of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas U.S. Minor Outlying Islands Utah Vermont Virgin Islands Of The U.S. Virginia Washington West Virginia Wisconsin Wyoming

*ZIP Code:

*Province:

Ontario Quebec Nova Scotia New Brunswick Manitoba British Columbia Prince Edward Island Saskatchewan Alberta Newfoundland and Labrador Northwest Territories Yukon Nunavut

*Foreign Postcode:

No spaces or dashes (example: A1A1A1)

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Claimant Background Information:

*Birth Date:

(mm/dd/yyyy)

*Gender:

Male Female

*Are you Hispanic or Latino?:

Yes No

*Race:

White Black or African American Asian American Indian or Alaska Native Native Hawaiian or Other Pacific Islander Other

*Highest education level attained:

NONE FIRST GRADE SECOND GRADE THIRD GRADE FOURTH GRADE FIFTH GRADE SIXTH GRADE SEVENTH GRADE EIGHTH GRADE NINTH GRADE TENTH GRADE ELEVENTH GRADE TWELFTH GRADE HIGH SCHOOL DIPLOMA GED CERTIFICATION COLLEGE FRESHMAN COLLEGE SOPHOMORE ASSOCIATE'S DEGREE COLLEGE JUNIOR COLLEGE SENIOR BACHELOR'S DEGREE MASTER'S DEGREE POST MASTER'S DOCTORATE DEGREE

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Veteran Status:

Are you a veteran of the U.S. Armed Forces?:

Yes No

*Have you served in the military within the last 18 months?:

Yes No

*Active Duty Start Date:

(mm/dd/yyyy)

*Active Duty End Date:

(mm/dd/yyyy)

*Pay Grade:

E-1 E-2 E-3 E-4 E-5 E-6 E-7 E-8 E-9 O-1 O-1E O-2 O-2E O-3 O-3E O-4 O-5 O-6 O-7 O-8 O-9 O-10 W-1 W-2 W-3 W-4 W-5

*Service Branch:

ARMY NAVY AIR FORCE MARINE CORPS COAST GUARD MERCHANT MARINES ARMY RESERVE NAVY RESERVE AIR FORCE RESERVE MARINE CORPS RESERVE ARMY NATIONAL GUARD AIR FORCE NATIONAL GUARD COAST GUARD RESERVE NOAA CORPS

*Do you have a service connected disability?:

No Yes

*Is your disability 30% or more?:

Yes No

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Claim Eligibility Information:

*During the past 18 months, have you worked as a civilian for the Federal Government?:

Yes No

*During the past 18 months, have you worked in a state other than NC?:

Yes No

*During the past 12 months, have you filed for or are you now receiving unemployment benefits in a state other than NC?:

Yes No

*Have you refused any work since you became unemployed?:

Yes No

*Are you currently working?:

Yes No

*Are you currently in school or receiving training?:

Yes No

*Are you receiving or applying for disability benefits under a state or federal law?:

Yes No

*Have you received, are you receiving, or are you entitled to receive vacation pay, severance pay, or bonus pay?:

Yes No

*Are you receiving, or will you receive, a pension, retirement pay, annuity or similar periodic payment, (not Social Security) contributed to by an employer for which you worked in the past 18 months, or Railroad Retirement Act payments?:

No Yes

*Effective date of the above payment:

(mm/dd/yyyy)

*Monthly amount of the above payment (before deductions):

numbers only

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Employment Information:

*Select your most recent employer:

OTHER / NOT LISTEDselect

*Company Name:

*Job Title:

maximum of 50 characters

*Brief description of job duties:

SORTING IRS MAIL

SORTING IRS MAIL

maximum of 130 characters

*First day worked:

(mm/dd/yyyy)

*Last day worked:

(mm/dd/yyyy)

*Reason for leaving:

FIRED/TERMINATED QUIT LAYOFF - LACK OF WORK STILL EMPLOYED SCHOOL EMPLOYEE BETWEEN TERMS

*Rate of pay:

U.S. dollars ($)

*Per:

HOURLY DAILY WEEKLY BI-WEEKLY MONTHLY YEARLY OTHER

*Were you employed less than 31 days?:

Yes No

*When you accepted this position did you intend it to last more than 30 calendar days?:

Yes No

*Occupational Title Match:
We need to match your occupation to one of the industry classified occupations. For this, please click the ‘Launch Occupation Match’ button below and you will be guided through the occupation matching search.

*Industry classified occupation title:

Information and Record Clerks, All Other

*Industry classified occupation description:

All information and record clerks not listed separately.

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Reemployment Information:

*New Job Title Match:
On the previous screen you provided us with the occupation you held with your last employer. We now need to know what occupation you will be seeking. For this, please click the ‘Launch Occupation Match' button below and you will be guided through the occupation matching search.

*Industry classified occupation title - for reemployment:

Office Clerks, General

*Industry classified occupation description - for reemployment:

Perform duties too varied and diverse to be classified in any specific office clerical occupation, requiring limited knowledge of office management systems and procedures. Clerical duties may be assigned in accordance with the office procedures of individual establishments and may include a combination of answering telephones, bookkeeping, typing or word processing, stenography, office machine operation, and filing.

*What are your total months of experience in the above occupation?:

(Max of 99)

*What is your lowest acceptable rate of pay?:

*Per:

HOURLY DAILY WEEKLY BI-WEEKLY MONTHLY YEARLY OTHER

*Have you previously registered to vote?:

Yes No

*Would you like to register to vote?: NO


   

Unemployment Benefits Claim Application

It appears that you have recently attempted to file a claim. Please contact the Customer Call Center at 1-888-737-0259 for additional assistance.