Scribd
Upload
31 views4 pages

Termination Letter

Uploaded by

dirtyhandscleanmoney435
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
31 views4 pages

Termination Letter

Uploaded by

dirtyhandscleanmoney435
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 4

Department of Workforce Services

PO BOX 143245
SALT LAKE CITY, UT 84114-3245

Date Mailed: 11-14-2024 Case Number: 18546500


PID: 041260584

MICHAEL JAMES RICHARDSON


790 W 100 S
HURRICANE, UT 84737-3228

Loss of Job Reported

Dear MICHAEL JAMES RICHARDSON

We received information MICHAEL JAMES RICHARDSON no longer works for FELLER ENTERPRISES LLC.

Have your employer complete the enclosed Employment Termination form. Return the completed form by 5:00
p.m. on 11-25-2024 or your benefits may end or your application may be denied.

How can you get us the verification we need?


You can send us your documents different ways. Choose the option that is easiest for you.
• Online: You can upload them at jobs.utah.gov/mycase.
• By fax: You can fax them at 1-877-313-4717 or 801-526-9500.
• By mail: You can mail copies to:
Department of Workforce Services
Imaging Operations
PO Box 143245
Salt Lake City, UT 84114-3245
• In person: You can drop off the copies at your local office.

Please write your name and case number on all documents you send.
<0138>

Toll free: 1-866-435-7414 Toll free FAX: 1-877-313-4717


Phone Number: 801-526-0950 FAX: 801-526-9500
DWS-ESD 631 State of Utah
Rev. 01/2022
Department of Workforce Services
EMPLOYMENT TERMINATION/LEAVE OF ABSENCE

Case name: Case number:


Employed person: SSN: E31824392470101:18546500
M RICHARDSON

Please use a black pen to complete form. This form is not used to determine Unemployment
Insurance eligibility.
Employer Information:
Company name:
Corporate name (if different):
Payroll company (if different):
Company address:
Name of supervisor or HR contact: Phone number:
Employee History:
1. Average hours the employee worked per week: Hourly wage: $
2. Date of hire: Last day worked:
3. Date final check available to the employee:
4. Gross amount (before taxes) of final paycheck:
5. Total gross pay (before taxes) in the month employee received their final check:
6. Did the employee receive severance pay or vacation pay separate from their final check? Yes No
If yes, how much? $ Date received:
7. Reason for leaving: Quit (state reason) Laid off (date)
Fired (state reason) Leave of absence (length)
Other (state reason)
8. Is this a temporary termination or furlough? Yes No
If yes, when is the employee expected to return to work for this company?
If yes, will the employee receive pay during their leave of absence? Yes No
9. Is there an option for continued medical insurance? Yes No
If yes, please list insurance carrier: Group #:
Policy number: COBRA amount: $
10. Does the employee have any retirement and/or 401K benefits? Yes No If yes, how much?
11. Any additional comments:

Employer Signature* Date


*Additional verification will be required if employer does not sign form.

Customer Signature Date


Return form to employee or to Department of Workforce Services:
Mail - Department of Workforce Services, Imaging Operations, P.O. Box 143245, Salt Lake City, UT 84114-3245
Fax - Salt Lake City Area: 801-526-9500 or Toll free: 1-877-313-4717
Questions? Call - Salt Lake City Area: 801- 526-0950 or Toll Free: 866-435-7414

Equal Opportunity Employer/Program


Auxiliary aids (accommodations) and services are available upon request to individuals with disabilities by calling 801-526-9240. Individuals
who are deaf, hard of hearing, or have speech impairments may call Relay Utah by dialing 711. Spanish Relay Utah: 1-888-346-3162.

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy