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The document emphasizes using blue or black ink, answering every question on each page, and thoroughly reviewing for completeness to avoid delays, denial of benefits, or penalties. 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Print or type the information. Use blue or black ink only.  \nAnswer all questions on each page. Review your application thoroughly for completeness. An incomplete application may delay or prevent the filing of your claim, or cause benefits to be denied. If the Employment Development Department (EDD) needs to verify any of the information you provide while filing a claim, you will receive additional forms by mail and will be asked to provide additional information and/or documentation.  \nAPPLICATION QUESTIONS  \nThe answers you give to the questions on this application must be true and correct. You may be subject to penalties if you make a false statement or withhold information.  \n\n| 1. Did you work in a state other than California during the last 18 months?\u003Cbr>AND / OR\u003Cbr>Did you work in Canada during the last 18 months? | 1.  Yes  No If yes, check the applicable box(es) below:\u003Cbr> State(s) Outside California, specify state(s):  \u003Cbr>\u003Cbr> Canada |  |  |  |\n| --- | --- | --- | --- | --- |\n| 2. What is your Social Security number as given to you by the Social Security Administration?\u003Cbr>a) If the EDD assigned you an EDD Client Number (ECN), please provide the ECN here. (An ECN is a 9-digit number beginning with 999 or 990 .) | 2.\u003Cbr>- - |  |  |  |\n|  | a) |  | - - |  |\n| 2A. List any other Social Security numbers you have used. | 2A.\u003Cbr>|  |  |  |\n| 3. What is your full name? | 3. Last   First   Middle Initial   |  |  |  |\n| 4. Is this the name that appears on your Social Security card?\u003Cbr>a) If no, provide the name that appears on your Social Security card. | 4.  Yes  No\u003Cbr>a) Last   First   Middle Initial   |  |  |  |\n| 5. List any other names you have used. | 5. |  |  |  |\n| 6. What is your birth date? | 6. |   (mm/dd/yyyy) |  |  |\n| 7. What is your gender? | 7.  |  Male  |  |  Female |\n| 8. What is your written language preference?\u003Cbr>a) What is your spoken language preference? | 8.  English  Spanish  Other  \u003Cbr>a)  English  Spanish  Other   |  |  |  |\n| 9. Have you filed a California Unemployment Insurance or a Disability Insurance claim in the last two years?\u003Cbr>a) If yes, list each type of claim and the most recent date(s) of when the claim(s) was filed. | 9.  Yes  No\u003Cbr>a) Unemployment Claim Date(s) (mm/dd/yyyy)\u003Cbr>a) Disability Claim Date(s) (mm/dd/yyyy) |  |  |  |\n\n DE 1101ID Rev. 6 (6-22) (INTERNET) Page 1 of 12 CU  \n1101I02  \nUNEMPLOYMENT INSURANCE APPLICATION  \nSocial Security number:  0 0 0  –  0 0  –  0 0 0 0   \n\n| 10. Do you have a Driver License issued to you by a State/entity?\u003Cbr>a) If yes, provide the name of the issuing State/entity\u003Cbr>and your Driver License number. If no, answer questions b-d:\u003Cbr>b) Do you have an Identification Card issued to you by a State/entity?\u003Cbr>c) If yes, provide the name of the issuing State/entity and your Identification Card number.\u003Cbr>d) How do you look for work and, if you have work, how do you get to work? |  |  |  | 10.  Yes  No\u003Cbr>a) Name of issuing State/entity:   Driver License Number:  \u003Cbr>If no, answer questions b-d:\u003Cbr>b)  Yes  No\u003Cbr>c) Name of issuing State/entity:   Identification Card Number:  \u003Cbr>d) Please Explain:  \u003Cbr>\u003Cbr>|  |\n| --- | --- | --- | --- | --- | --- |\n| 11. What is your telephone number?\u003Cbr>a) If you are deaf, hard of hearing, or have a speech disability and use TTY or California Relay to communicate, check the appropriate box. |  |  |  | 11.  – – \u003Cbr>a)  TTY (Non-voice)  California Relay Service |  |\n| 12. What is your mailing address?(Include your city, State, and ZIP code) |  |  |  | 12. Street:   Apt.:  \u003Cbr>City:   State:   ZIP Code:   |  |\n| 13. Is your residence address the same as your mailing address?\u003Cbr>a) If no, enter your residence address. (Include your city, State, ZIP code and apartment number. ) A residence address cannot be a P.O. Box. Please provide a street address. |  |  |  | 13.  Yes  No\u003Cbr>a)","cbCaif1gqqcD44zI","https://ap.wps.com/l/cbCaif1gqqcD44zI","pdf",808064,"English","# Filing Instructions\n# Application Questions\n## Employment and wages information","[{\"question\":\"What are the key requirements for completing the application?\",\"answer\":\"Complete the application and any applicable attachments, print or type the information, use blue or black ink, and answer all questions on each page.\"},{\"question\":\"What happens if the application is incomplete?\",\"answer\":\"An incomplete application may delay or prevent filing of the claim, or lead to benefits being denied.\"},{\"question\":\"Can the Employment Development Department request more information?\",\"answer\":\"Yes. If EDD needs to verify information during the claim process, additional forms may be sent by mail and you may be asked to provide more information and/or documentation.\"}]","UNEMPLOYMENT INSURANCE APPLICATION - Filing Instructions | PDF",1789832872]