Purpose
To obtain information we need to determine the eligibility of an individual currently or formerly in your employ who: (See Form)

(1)  Worked for you during his/her lag period; that is, the calendar quarter in which he/she filed a new claim for unemployment benefits and the immediately preceding calendar quarter; or

(2)  Was not a covered employee as defined by the New Jersey Unemployment Compensation Law and, therefore, for whom you were not liable to pay contributions (taxes) for unemployment insurance purposes; or

(3)  Reopened his/her claim for unemployment benefits.

Note: When a claimant files an initial claim, a benefit year of 52 weeks is established.  If the claimant obtains new employment or returns to his/her former employment, the claim is closed. The claim can, however, be reopened at any time during those 52 weeks if the claimant again becomes unemployed and still has some benefits for which he/she may qualify.

Use
This information will be used to determine if the claimant is eligible for benefits.

Use by Employer
Complete this form and return it to the specified office only if:

1.  The claimant was separated for reason(s) other than lack of work.
If the claimant was separated for reasons other than lack of work, he/she may not be eligible for unemployment benefits. You should be as specific as possible as to the reason for separation.

2.  The claimant is receiving a company pension. Receipt of a pension may affect the amount of benefits a claimant is entitled to receive.

3.  The claimant received wages for a period after his/her last day of work (for example, vacation pay, severance pay, payment in lieu of notice, etc.). Receipt of monies for a period after the last day of work may affect a claimant's eligibility.

4.  The claimant's separation is temporary and the claimant has a definite date to return to work.