RETURN OF WORK SHARING CERTIFICATION - CLAIMANT

Please follow the instructions checked below. If instructed to do so, provide the requested information or make the necessary corrections/clarifications to the Work Sharing Certification. Return the requested information or Work Sharing Certification to the Special Claims Office in the enclosed envelope by MM/DD/YYYY. Failure to do so may affect your eligibility for benefits

1. Please complete the items marked in red and return the certification in the envelope provided.
2. Your employer states you were absent during the week ending MM/DD/YYYY. Please review your answer marked in red on the attached certification, correct and/or clarify your answer as appropriate and return the certification in the envelope provided.
3. Your Unemployment Insurance claim has ended. Complete the attached document and return in the envelope provided to file a new claim.
4. You are not entitled to partial benefits as you have previously received Work Sharing benefits while with the same employer during the current benefit year. Please request a Work Sharing Certification from your employer.
5. Because another customer is using Social Security numberBlank Line__________________ , we are assigning you an EDD Client Number. A Notice of Unemployment Insurance Award, DE 429Z, with your new number will be mailed to you. The new number is:Blank Line__________________ . Please use this new number when contacting or writing to this office. Do not use this number for any other purpose.
6. Mail proof of employment for the past two years (check stubs, W-2, letter from employer, etc.) in the envelope provided. This information is necessary to establish a valid Unemployment Insurance claim.

NOTE: Under certain conditions Disability Insurance and/or Workers' Compensation benefits may be used to validate your claim. If you have received either benefit mail proof of payment for the past two years.

Special Claims Office P.O. Box 419076 Rancho Cordova, CA 95741-9076 (916) 464-3300

DE 1159WS Rev. 9 (11-15) (INTRANET)

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UI / DE 1159WS

RETURN OF WORK SHARING CERTIFICATION - CLAIMANT