Form DWS-ARK-502 RB "Weekly Claim Form for Unemployment Benefits" - Arkansas

What Is Form DWS-ARK-502 RB?

This is a legal form that was released by the Arkansas Department of Workforce Services - a government authority operating within Arkansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2005;
  • The latest edition provided by the Arkansas Department of Workforce Services;
  • Easy to use and ready to print;
  • Available in Vietnamese;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DWS-ARK-502 RB by clicking the link below or browse more documents and templates provided by the Arkansas Department of Workforce Services.

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Download Form DWS-ARK-502 RB "Weekly Claim Form for Unemployment Benefits" - Arkansas

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CLAIMANT NAME
SSN
BYR
OFFICE
PROG
WSC
WBA
I CLAIM BENEFITS FOR THE WEEK BEGINNING ON SUNDAY AND ENDING ON SATURDAY ________________________________________ .
THE FOLLOWING QUESTIONS REFER TO THE ABOVE WEEK.
YES
NO
(A) LAST DAY WORKED ____________________ .
1.
DID YOU WORK, HAVE HOLIDAY PAY OR RECEIVE PAY FOR
DOLLARS
CENTS
HOURS
MILITARY DRILL OR SELF-EMPLOYMENT FOR WHICH YOU
WERE PAID OR WILL BE PAID? IF YES, ENTER TOTAL
AMOUNT BEFORE DEDUCTIONS AND COMPLETE ITEMS
A, B, AND C TO THE RIGHT. CIRCLE TYPE OF PAY.
2.
DURING EACH DAY OF THE WEEK WERE YOU ABLE AND
(B)
QUIT
DIS-
STILL
OTHER
LACK OF
AVAILABLE TO WORK? ......................................................
CHARGED
EMPLOYED
WORK
3.
DID YOU REFUSE WORK OR A REFERRAL TO WORK, RE-
FUSE RECALL TO A FORMER EMPLOYER, QUIT A JOB,
GET FIRED, SUSPENDED FROM A JOB, BEGIN ATTENDING
SCHOOL OR A TRAINING PROGRAM? ................................
(C)
EMPLOYER’S NAME AND ADDRESS
4.
DURING THE WEEK, DID YOU APPLY FOR OR BEGIN
RECEIVING ANY TYPE OF VACATION, SEPARATION,
BONUS, OR RETIREMENT PAY EXCLUDING SOCIAL SECU-
_________________________________________
RITY? CIRCLE TYPE OF PAY. ..........................................
5.
HOW MANY JOB CONTACTS DID YOU MAKE IN THIS
_________________________________________
WEEK? WRITE NUMBER IN BOX. .......................................
_________________________________________
IF YOU ARE REQUIRED TO REPORT YOUR CONTACTS
IN WRITING, PLEASE WRITE THEM IN THE SPACE PRO-
VIDED IN YOUR BENEFITS INFORMATION HANDBOOK.
MAIL THIS CLAIM FORM AFTER SATURDAY DATE SHOWN ABOVE.
CERTIFICATION: I CERTIFY THAT THE ANSWERS
GIVEN ABOVE ARE TRUE AND ACCURATE TO THE
SIGNATURE: ________________________________________________
BEST OF MY KNOWLEDGE. I AM NOT CLAIMING OR
RECEIVING ANY BENEFITS FROM ANOTHER UNEM-
IF YOUR ADDRESS HAS CHANGED, SHOW CHANGE BELOW.
PLOYMENT PROGRAM FOR THE ABOVE WEEK. I AM
AWARE I MAY BE PENALIZED FOR GIVING FALSE
ANSWERS AND FOR WITHHOLDING INFORMATION.
o
o
ADDRESS CHANGE:
YES
NO
NAME:
IF YOU HAVE RETURNED TO WORK FULL-TIME AFTER THE
SATURDAY DATE SHOWN ABOVE, COMPLETE BELOW.
STREET OR BOX NO.:
DATE BEGAN WORK:
o
FULL-TIME
o
CITY:
STATE:
ZIP CODE:
PART-TIME
EMPLOYER NAME:
PHONE NO.: (
)
STREET OR BOX NO.:
RETURN THIS CARD TO THE LOCAL OFFICE ADDRESS LISTED
CITY:
STATE:
ZIP CODE:
BELOW AS INSTRUCTED BY YOUR LOCAL OFFICE.
o
MAIL IN AFTER SATURDAY DATE ABOVE.
o
BRING IN ON _____________________________________
SCHEDULED DATE
L.O. USE:
DWS-ARK-502 RB (Rev. 7-05) CLAIM FOR UNEMPLOYMENT BENEFITS-REGULAR
CLAIMANT NAME
SSN
BYR
OFFICE
PROG
WSC
WBA
I CLAIM BENEFITS FOR THE WEEK BEGINNING ON SUNDAY AND ENDING ON SATURDAY ________________________________________ .
THE FOLLOWING QUESTIONS REFER TO THE ABOVE WEEK.
YES
NO
(A) LAST DAY WORKED ____________________ .
1.
DID YOU WORK, HAVE HOLIDAY PAY OR RECEIVE PAY FOR
DOLLARS
CENTS
HOURS
MILITARY DRILL OR SELF-EMPLOYMENT FOR WHICH YOU
WERE PAID OR WILL BE PAID? IF YES, ENTER TOTAL
AMOUNT BEFORE DEDUCTIONS AND COMPLETE ITEMS
A, B, AND C TO THE RIGHT. CIRCLE TYPE OF PAY.
2.
DURING EACH DAY OF THE WEEK WERE YOU ABLE AND
(B)
QUIT
DIS-
STILL
OTHER
LACK OF
AVAILABLE TO WORK? ......................................................
CHARGED
EMPLOYED
WORK
3.
DID YOU REFUSE WORK OR A REFERRAL TO WORK, RE-
FUSE RECALL TO A FORMER EMPLOYER, QUIT A JOB,
GET FIRED, SUSPENDED FROM A JOB, BEGIN ATTENDING
SCHOOL OR A TRAINING PROGRAM? ................................
(C)
EMPLOYER’S NAME AND ADDRESS
4.
DURING THE WEEK, DID YOU APPLY FOR OR BEGIN
RECEIVING ANY TYPE OF VACATION, SEPARATION,
BONUS, OR RETIREMENT PAY EXCLUDING SOCIAL SECU-
_________________________________________
RITY? CIRCLE TYPE OF PAY. ..........................................
5.
HOW MANY JOB CONTACTS DID YOU MAKE IN THIS
_________________________________________
WEEK? WRITE NUMBER IN BOX. .......................................
_________________________________________
IF YOU ARE REQUIRED TO REPORT YOUR CONTACTS
IN WRITING, PLEASE WRITE THEM IN THE SPACE PRO-
VIDED IN YOUR BENEFITS INFORMATION HANDBOOK.
MAIL THIS CLAIM FORM AFTER SATURDAY DATE SHOWN ABOVE.
CERTIFICATION: I CERTIFY THAT THE ANSWERS
GIVEN ABOVE ARE TRUE AND ACCURATE TO THE
SIGNATURE: ________________________________________________
BEST OF MY KNOWLEDGE. I AM NOT CLAIMING OR
RECEIVING ANY BENEFITS FROM ANOTHER UNEM-
IF YOUR ADDRESS HAS CHANGED, SHOW CHANGE BELOW.
PLOYMENT PROGRAM FOR THE ABOVE WEEK. I AM
AWARE I MAY BE PENALIZED FOR GIVING FALSE
ANSWERS AND FOR WITHHOLDING INFORMATION.
o
o
ADDRESS CHANGE:
YES
NO
NAME:
IF YOU HAVE RETURNED TO WORK FULL-TIME AFTER THE
SATURDAY DATE SHOWN ABOVE, COMPLETE BELOW.
STREET OR BOX NO.:
DATE BEGAN WORK:
o
FULL-TIME
o
CITY:
STATE:
ZIP CODE:
PART-TIME
EMPLOYER NAME:
PHONE NO.: (
)
STREET OR BOX NO.:
RETURN THIS CARD TO THE LOCAL OFFICE ADDRESS LISTED
CITY:
STATE:
ZIP CODE:
BELOW AS INSTRUCTED BY YOUR LOCAL OFFICE.
o
MAIL IN AFTER SATURDAY DATE ABOVE.
o
BRING IN ON _____________________________________
SCHEDULED DATE
L.O. USE:
DWS-ARK-502 RB (Rev. 7-05) CLAIM FOR UNEMPLOYMENT BENEFITS-REGULAR
This form is to be used by the person to whom it was issued. Do not give it to anyone else for the purpose of claiming benefits.
Instructions For Completion of Your Weekly Claim Form
Following are instructions on how to fill out your claim form. After reading these instructions, if you have questions on the completion of the form, ask your local office
for assistance.
The week ending date you will be claiming is to be entered in the space provided. Answer the questions on each weekly claim with respect to the week you are claiming.
Question #1: Darken the circle under the no if you did not work during the week ending date on the claim or receive holiday pay, vacation pay, or pay for military drill
or self-employment for the week you are claiming. Darken the circle under the yes if you worked or received or will receive holiday pay, vacation pay, or pay for military
drill or self-employment for the week you are claiming.
Draw a circle around the appropriate word(s). If you worked during the week being claimed, draw a circle around the word “work”. If you received or will receive holiday
pay for the week being claimed, draw a circle around the words “holiday pay”. If you received or will receive vacation pay for the week being claimed, draw a circle around
the words “vacation pay”. If you had military drill during the week being claimed, draw a circle around the words, “military drill”. If you worked in self-employment
during the week being claimed, draw a circle around the words, “self-employment”.
If your answer is yes to question #1, you must also answer questions (a), (b) and (c) on the right hand side of the claim form in accordance with the
following instructions:
(A) Last Day Worked
If you worked for an employer, performed self-employment, or had military drill during the week claimed, enter the last day you worked, performed
self-employment, or had military drill during the week.
Earnings
Enter the gross amount before deductions that you were paid or will be paid for the week for work, holiday pay, vacation pay, military drill or self-em-
ployment in the boxes marked “dollars” and “cents”.
Hours Worked
Enter the number of hours that you worked. Use whole number of hours only. For example, if you worked 14 1/2 hours, enter 14 hours.
(B) Reason For Separation
If you worked during the week being claimed and you are separated from work during that week, darken the circle that applies (lack of work, quit,
discharged or other). If you worked during the week and you are still working for that employer, darken the circle in the “still employed” box.
(C) Employer Name and Address
If you worked during the week you are claiming, enter the name and address of the employer for whom you worked.
Question #2: Darken the circle under the yes if you were able and available to work each day of the week you are claiming. Darken the circle under
the no if you were not able and available to work each day of the week you are claiming. If you answered no to question #2, you will need to give your
local office a statement. Contact your local office before mailing your claim form and provide the local office with detailed information as to why you
were not able and available to work each day of the week.
Question #3: Darken the circle under the yes if during the week you are claiming, you refused work or a referral to a job, refused recall to a former
employer, quit a job, were fired, suspended from a job, or began school or a training program.
Draw a circle around the appropriate word(s). If you refused any kind of work during the week being claimed, draw a circle around the words “refuse
work”. If you refused a referral to work during the week being claimed, draw a circle around the words “referral to work”. If you refused recall to a
former employer during the week being claimed, draw a circle around the words “refuse recall to a former employer”. If you quit a job during the week
being claimed, draw a circle around the words “quit a job”. If you were fired (discharged) from your job during the week being claimed, draw a circle
around the words “get fired”. If you got suspended from your job during the week being claimed, draw a circle around the words “suspended from a
job”. If you started attending school or a training program during the week being claimed, draw a circle around the words “began attending school or
a training program”.
If your answer is yes to question #3, you will need to give your local office a statement. Contact your local office before mailing your claim form to
provide them with a detailed statement as to why you answered yes to this question. Darken the circle under no if during the week being claimed, you
did not refuse work, quit a job, get fired or suspended from a job or begin school or a training program.
Question #4: Darken the circle under the yes if during the week being claimed, you applied for or began receiving vacation, separation, bonus, or
retirement pay. Draw a circle around the appropriate word(s). If you received or will receive separation pay for the week being claimed, draw a circle
around the word “separation”. If you received a bonus payment (including profit sharing) during the week being claimed, draw a circle around the
word “bonus”. If you applied for or began receiving retirement pay (excluding social security) during the week being claimed, draw a circle around the
words “retirement pay”.
If your answer is yes to question #4, you will need to give your local office a statement. Contact your local office before mailing your claim form to pro-
vide them with detailed information as to why you answered yes to this question. Darken the circle under the no if during the week you are claiming,
you did not apply for or begin receiving vacation, separation, bonus or retirement pay.
Question #5: Enter the number of job contacts you made during the week in the box beside this question. If you are not required to make job contacts,
enter 0.
Reporting Job Contacts
If you are required to record your job contacts each week, you need to enter all the required information on your job contacts for the week you are
claiming on the form provided in the back of your information handbook.
Address and Telephone Number Changes
If you have changed your address since last claiming, enter your new address and/or telephone number in the space provided.
Signature
Please be sure to sign your name in the space provided on the claim form.
Mailing Your Weekly Claim Form
Once you have completed your weekly claim form, check it for accuracy. The appropriate mailing address will be on the claim form. If you have re-
turned to full-time work, please enter the employer information in the “return to work information” section. You will need to mail your weekly claim
after the week ending date being claimed. You have seven (7) days from the week ending date you are claiming to submit your weekly claim form in
a timely manner. If you need assistance in completing your weekly claim form, contact your local employment office.
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