Get Ides Academic Personnel Questionnaire

Print State of Illinois Department of Employment Security www. ides. illinois. gov Academic Personnel Questionnaire - Claimant Claimant Information Last Name ID or SSN First Name MI Este es un documento importante. Si usted necesita un int rprete p ngase en contacto con su oficina local* Under Section 612 of the Illinois Unemployment Insurance Act an individual is ineligible for benefits on the basis of wages for employment from an educational institution for any week between two successive years or terms if the individual either has a contract or has reasonable assurance he/she will perform such services in the next academic year or term* The information you provide will be used for the purpose of determining your eligibility for benefits. Please complete sign and return this questionnaire to your Illinois Department of Employment Security Local Office as instructed* Failure to respond will result in a determination based on the available information* If you need additional space please use the other side of this document if appropriate or attach a separate sheet of paper. Office Use Only What type of work did you perform for your last employer Rate of pay Per Section A Academic Information What is the name of your last academic employer What were the dates of employment / From Did your employment end with the end of an academic year or term or at the start of a vacation period or holiday recess What is the reason for your unemployment Summer break Semester break To Yes No Select One Paid sabbatical Customary vacation period Holiday recess Other Please Explain Had you been employed by an academic institution during a prior academic year or term If Yes please answer the following How many years or terms have you been employed by an academic institution In previous years did your employment end with the end of the academic year or term If No explain why you were not rehired years What was your title at your last academic institution Were you a substitute How many days did you normally average per week as a substitute days Have you registered for substitute teaching for the next academic year or term If Yes names of academic institutions If No reason for failure to sign up Do you have a written verbal or implied agreement to work for an academic institution in the next academic year term or the period immediately following the vacation period or holiday recess If Yes in what capacity Do you have reason to believe that you will be rehired to work for the next academic year or term If Yes no further questions are required* Skip to Section B. If No why do you believe that you will not be rehired for the next academic year or term Did you refuse any offer of employment with any academic institution If Yes what was the date of refusal Name of academic institution Section B Signature Date Name Printed or Typed ADJ004FC P age 1 of 1 Telephone Number Signature QU29CE Rev* 09/2011. Si usted necesita un int rprete p ngase en contacto con su oficina local* Under Section 612 of the Illinois Unemployment Insurance Act an individual is ineligible for benefits on the basis of wages for employment from an educational institution for any week between two successive years or terms if the individual either has a contract or has reasonable assurance he/she will perform such services in the next academic year or term* The information you provide will be used for the purpose of determining your eligibility for benefits. Please complete sign and return this questionnaire to your Illinois Department of Employment Security Local Office as instructed* Failure to respond will result in a determination based on the available information* If you need additional space please use the other side of this document if appropriate or attach a separate sheet of paper.