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Unemployment Insurance Constituent Service
By filling out this form, you are giving Delegate Levine's staff permission to share your information with the Virginia Employment Commission.
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Email Address
*
Your answer
Phone Number (please use the same phone number you used when applying for unemployment and/or PUA)
*
Your answer
Last Four Digits of Social Security Number
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Your answer
Have you filed for UI and/or PUA online at the VEC website?
*
Yes
No
If yes, what type?
Regular State Unemployment Insurance
PUA
PEUC
Clear selection
Have you received a monetary determination from the VEC?
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Yes
No
What is your reason for unemployment?
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Voluntarily quit
Terminated
Hours reduced
Separated due to lack of work
Other:
If other, provide more information:
Your answer
Have you been filing weekly claims on the VEC website or though the 1-800 number?
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Yes
No
Are you self-employed, a gig worker, a 1099 filer, or independent contractor?
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Yes
No
Have you received UI benefits in the last twelve months?
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Yes
No
Have you exhausted your unemployment benefits?
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Yes
No
Unsure
I have not received anything yet.
Have you been told there is an issue on your claim? YES or NO, and if YES please briefly explain.
*
Your answer
Have you had contact with another legislative office on this matter?
*
Yes
No
If you have had contact with another legislative office about this, which one?
Your answer
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