2/23/23, 4:08 AM Confirmation — Application Submitted

Confirmation — Application Submitted

You Successfully Submitted Your Application
TYRONE NELSON, you submitted an application for unemployment benefits on February 23, 2023. Your confirmation number is 40458324. Keep
this number for your records.

We are currently processing applications and will contact you if we need any additional information within the next few weeks. Meanwhile, visit
After You Apply for important steps you must take to make sure your benefit payments are not delayed or denied.

Important Next Steps

Visit After You Apply to learn about important steps you must take to be eligible for benefits, such as:

Looking for important documents from the EDD. Once your application is processed, we will mail documents to you with information
about your claim.
Notice of Unemployment Insurance Claim Filed (DE 1101CLMT) (PDF)
Notice of Unemployment Insurance Award(DE 429Z) (PDF)
Employment Development Department Customer Account Number Notification (DE 5614) (PDF)
Unemployment Insurance Benefits: What You Need to Know (DE 1275B) (PDF)
Continued Claim (DE 4581) (PDF)

Certifying for benefits every two weeks. You must certify to receive benefits. Use UI Online to quickly tell us if you are still unemployed.
You can also access your claim history, view your payment history, request tax forms, and check your inbox.
Registering for CalJOBSSM. Use CalJOBS to search for jobs, build résumés, access career resources, and gather information on education
and training programs.

We recommend you bookmark the After You Apply page for later reference.

Canceling a UI Claim
To cancel a claim, do not certify for benefits.

You can only cancel a claim if you meet all of the following requirements:

Benefits have not been paid.

You haven’t been issued a written notice of disqualification.
There is no overpayment from a previous claim.
The benefit year of your claim has not ended.

Once a claim is canceled, you cannot submit an application for a new claim using the same beginning date.

Applicant Information

First Name
TYRONE

Middle Initial
J

Last Name
NELSON

Social Security number (SSN)

XXX-XX-6327

Date of Birth

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02/22/1959

1. Gender
Male

2. If you have used any other names, list them.

Contact Information
1. What is your mailing address?

Location
United States

Number, Street, and Apartment/Unit or PO Box Number

278 Columbia St Apt 2

City
Duryea

State
PA - Pennsylvania

ZIP Code
18642

2. Is your residence address the same as your mailing address?

No

Provide your residence address.

Location
United States

Number, Street, and Apartment/Unit

3711 19th Ave

City
San Francisco

State
CA - California

ZIP Code
94132

3. If you do not live in California, select the name of the county or county-equivalent (for example, parish, borough,
census area, independent city, etc.) where you live.
Adams County, PA

4. Phone Number
2486781969

4a. Phone Type

Home Phone

Citizenship Information
1. Are you a U.S. citizen or national?
Yes

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Statistical Information
1. Education
Bachelor's Degree

2. Are you a veteran?

No

3. What race or ethnic group do you identify with?

White, not Hispanic

4. Do you have a disability?

No

5. What is your preferred spoken language?

English

6. What is your preferred written language?

English

Last Employer
Employer Name Employer Mailing Address Employer Physical Address

You indicated you did not work for any

employer within the last 18 months. If you
would like to change your response, select
Modify.

School Employee Information

1. Did you work for or provide services to or on behalf of any educational institution between 10/01/2021 to today?
No

Availability Information
1. What type of work do you normally perform?
CONTRACTOR

2. What other type of work can you perform?

BUILDING CONSULTANT

3. Is the type of work you normally perform seasonal?

No

4. Do you expect to return to work for a former employer?

No

5. Do you have a date to start work?

No

6. Are you ready and willing to accept work that matches your work skills and educational background? (Example: If
offered a job, would you be able to accept it?)
Yes

7. Are you currently self-employed (have your own business or work as an independent contractor) or plan to become
self-employed?
No

8. Are you a member of a union or a non-union trade association?

No
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Additional Information
1. Are you receiving, or will you receive within the next two weeks, a pension or retirement that is not Social Security
or Railroad Retirement, which is based on your own work or wages?
No

2. Are you receiving or do you expect to receive workers' compensation?

No

3. Are you currently attending or have a scheduled start date to attend school or training?
No

4. Are you now or have you been in the last 18 months an officer of a corporation, officer of a union, or the sole or major
stockholder of a corporation?
No

Disaster Information
1. Are you unemployed as a direct result of a recent disaster (for example: earthquake, flood, mudslide, or fire) in
California?
Yes

1a. Select the type of disaster.

Flood

1b. At the time of the disaster, in which county did you reside?
Alameda County

1c. At the time of the disaster, in which county did you work?
Alameda County

1d.At the time of the disaster, was your unemployment caused by your need to travel through a disaster county?
No

1e. Select the option that best applies to you.

Head of Household As a Result of the Disaster

1e.1. How many hours did you work per week prior to the disaster?

1e.2. Explain briefly how the disaster affected your ability to continue or begin your self-employment.

1e.3. What is the physical address of your business?

Number and Street

City

State

ZIP Code

I declare under penalty of perjury that the information I provided is true and correct to the best of my knowledge or belief. I
understand that I can be subject to legal action and administrative penalties if I make false statements or withhold facts to
receive benefits.

Rate Your Experience

Complete the optional survey below to tell us about your UI Online experience. Your feedback will help us make future improvements.

1. How would you rate your overall experience using UI Online?

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Excellent
Good
Average
Poor
Very Poor

2. Provide a brief explanation describing why you chose the experience rating above. (Optional. 250 character
limit)
Do not enter questions or comments about your UI claim or benefits. If you have questions or comments,
Contact the EDD.

(Maximum 250 Characters)

Log Out

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