Document 1yr7gdonOy8rYE5jQkyzovroX

CTWI 4-001302 EMPLOYMENT APPLICATION A M E R I CA N CYA N A M I D COM PA N Y Alt applicants will be given equal consideration regardless of Race. Sex. Age, Color, National Origin, Marital Status. Religion or Physical Disability. Any answers to questions on this form will not be used to discriminate against any applicant. CONFIDENTIAL INFORMATION REDACTED PLANT, OFFICE OR LABORATORY. n a me (Lost, First, MiddU) . --,, PRESENT AOORESS PERMANENT NO T1FV .N EMCROBNCY J a* . A ^ ft / STREET C A :C * CITY ^ (( f l STREET . ST"1 CITY Bfit.jL-f' /*& t CA>C4r3 0 TYPE OF POSITION APPLIED POP: REFERRED TO THIS COMPANY SYt Z7 .s_______ ARE YOU PRESENTLY EMPLOYED* y NA 6641 t // /V Try/ STATE /< STATS C otj $ ZIP CODE /t ZIP COOS STATE ZIP CODE WMAT MINIMUM SALARY WOULD YOU ACCEPT* MAYS YOU SEEK EMPLOYED EV THIS COMPANY SB PORE* Q TEE FTNQ T EMPLOYER* CYWI 4-001303 r edac t ed PLEASE NOTE - IMPORTANT - COMPLETE NEXT TWO LINES IF APPLICATION FOR SALES EMPLOYMENT WHAT PRODUCTS OR SERVICES HAVE YOU SOLD? HAS YOUR DRIVER'S LICENSE EVER BEEN SUSPENDED? no yes If Yes, Why? BRANCH OF SERVICE U. S. MILITARY HISTORY DATE ENTERED DATE OF DISCHARGE WHAT WAS THE NATURE OF YOUR PRINCIPAL SERVICE ASSIGNMENT? WAS DISCHARGE OTHER THAN DISHONORABLE' EMPLOYMENT HISTORY IMPORTANT - LIST EVERY EMPLOYMENT WHETHER OR NOT IT SEEMS RELEVANT TO POSITION APPLIED f o r . IF LAPSES OCCURRED BETWEEN PERIODS OF EMPLOYMENT. GIVE DATES OF. AN D REA SON FOR UN EMPLOYMENT. NAME OF EMPLOY ER r' ^ TE-EPHONE OF EMPLOYER S s <*-/ - j > j' POSITION OR TITLE _C- h c Ac y DESCR'PTICN OF Du t ie s . PRESENT OR LAST EMPLOYER ADDRESS Oc EMPLOYER SC.? c - SUPERVISOR'S NAME & TITLE __________ ^__________________________ c(-., c rt L c D P A R TMEN T r} l C /| t` m i X REA SO N FOR LEAVING y/a / C/ DATE EMPLOY ED / r,r,7</\ ft M c. SA* * t MC. DAY RATE Op PAY *R. _ , r*r\A CYWI 4-001304 5S55ES$ r edac t ed EMPLOYMENT HISTORY fcontinued* NEXT PREVIOUS EMPLOYER N AME OP EMPLOY ER , _/ t e l e p h o n e o f e mp l o y e r J -f%' - 3 5 3 c'' ^ i-~i-- J <- H* /4DOPESSOF EMPLOYER r a DATE EMPLOY ED / r: / 7 & r / ?>_ s, j. // L.&&.ZX 40. OAY T, SUPERVISOR'S NAME * TITLE J o c-i DEPARTMENT / RATE OF PAY unJrf-K^St Stort 1 //AJ//Y *0. OAT TS. POSITION OR TITLE (2 h <?< A cr r" r Ea s o n f o r l e a v i n g DESCRIPTION OP OUTIES: L /> X o f -b h} E?NAME OF EMPLOYER TELEPHONE OF EMPLOYER POSITION OR TITLE 7c: h < t ' DESCRIPTION OF DUTIES: "Z. 1 SC NEXT PREVIOUS EMPLOYER 1 AODRESSOF EMPLOYER 6>_____ LtJ. ^ SUPERVISOR'S NAME % TITLE DEPARTMENT /"t- / N C > >'-? / / REASON FOR LEAVING (7 / <r/. 1/9-1________f " /)* S DATE EMPLOYED i m,7# MO. OAY r*. 6 MO. OAY RATE OF PAY YU. Stort Finish . TYPE OF SCHOOL 1. Grade School 2. High School 3. College 4. Post'Grad DATE FROM TO Mo./Y r. Mo./Y r* c/ c/ EDUCATION HISTORY NAME ANO ADDRESS MAJOR COURSE YV> No ACADEMIC AVERAGE DEGREE S. Business or Trade 6. Other UNDERGRAO. CLASS RANK (Example: 10th in 100) WHAT OFFICE MACHINES CAN YOU USET % COLLEGE EXPENSES EARNED TYPING SPEED SHORTHAND SPEED WHAT FOREIGN LANGUAGES DO YOU SPEAK, READ OR WRITE HONORS ANO PROFESSIONAL MEMBERSHIPS FOR THOSE WHO HAVE ATTENDED COLLEGE loat 5l is t n a me s OF p r in c ip a l c o l l e g e INSTRUCTORS. (If ottandod within th# yaors) PUBLICATIONS SUBJECT OF THESIS 4-001305 CYW1 __________ NAME e) 2 0 A'l " LIST BELOW THREE REFERENCES, NOT PREVIOUSLY MENTIONED AND NOT RELATED TO YOU, WHO HAVE KNOWN YOU FOR AT LEAST THREE YEARS ADDRESS, STREET, CITY. ZIP STATE ' / YcH /5 S'. `vd / ? /c NATURE OF BUSINESS <h< i i, TELEPHONE NO. I HEREBY AFFIRM that my answers to the foregoing questions are true and correct, and I understand that misrepresentation or omission of facts called for in this application or other compeny records, may be cause for immediate dismissal without notice if subsequently employed. I authorize inquiry with regard to my character, ability and habits of any and all persons and agree to hold such persons harmless with respect to any information they may give. I AM AWARE that the Company generally requires that an employment agreement be signed at the time of employment that contains clauses requiring (A) non-disclosure and non-use of confidential information both during employment and thereafter, and (B) for not more than one year after termination of employment, restrictions on employment by others involving similar products or processes worked on for the Company within two years of termination of employment, and (C) appropriate notice by either party in event of termination. I further understand that all new employees will be subject to a medical examination as a condition of employment. These examinations are to be made by a physician designated by the Company. When employed, the following must be furnished: Social Security Card Birth Certificate or Other Proof of Age and-Citizenship Military Discharge, If a Veteran If Non-Citizen, Visa SIGMATUREX) F APPLICANT DATE Sr-yc r t INTERVIEWED BY DATE APPLICANT NOT TO USE SPACE BELOW DEP T. g e n e r a l IMPRESSION TO REPO RT TO PERSONNEL WILL COMPLETE AFTER ACCEPTANCE OF EMPLOYMENT DIVISION ft d e p a r t me n t d a t e o f b ir t h STARTING DATE EXEMPTION STATUS ADOlTtON OR REPLACEMENT EMPLOYED AS (Cl a s s if ic a t io n ' LEVEL AND RATE RANGE RATE OF P AY PCA REMARKS: c i t i 2. e n s h ip MILITARY STATUS APPROVED BY MEDICAL DEPT. X CYWI 4-001306 UC (HO Ben-134 P (Rev. 4-74) STATE OF ILLINOIS - DEPARTMENT OF LABOR BUREAU OF EMPLOYMENT SECURITY DIVISION OF UNEMPLOYMENT COMPENSATION NOTICE OF CLAIMS ADJUDICATOR'S DETERMINATION NAME Address all communications regarding this nutter to: Division of Unemployment Compensation 1024 S. Wabasn Chicago, Illinois and refer to this S.S, NO. and Name above In connection with the claim for unemployment compensation benefits filed by the above named claimant, the following determination has been made. T Further information is given in the paragraph checked below: 1. VJ As a party entitled to notice of the claims adjudicator's determination (see reprint of Regulation 14, Section B, on the other side), your attention is called to Section 800 of the Unemployment Compensation Act, which provides that "unless the claimant or any other party entitled to notice of the claims adjudicator's... `determination'... within nine (9) calendar days after such notification was mailed to his last known address, files an appeal therefrom, such... `determination' shall be final, as to all parties given notice thereof. " APPEAL RIGHTS: IF YOU DISAGREE WITH THIS DETERMINATION, You may file an appeal, in person or by mail. Your appeal must be FILED in this office within nine (9) days after the date of this notice if it was mailed to you. or within seven (7) days after the date of this notice if it was given to you. Any appeal submitted by mail must bear a postmark date within the applicable time limit for filing. A LETTER WILL SUFFICE IF YOU DO NOT HAVE APPEAL FORMS. 2. Your attention is called to Regulation 14, Section B, which is reprinted on the other side of this letter. Our records indicate that you did not submit a Notice of Possible Ineligibility giving the required information for this claimant within the time limit prescribed by this regulation. The information you submitted was, however, considered when the above determination was made. This letter is sent to you for information only. Under the provisions of Regulation 14, this information may not be made-the basis of an appeal. [f you desire any further information concerning this claim, please, communicate with the claims adjudicator at. the local office or phone number given above. 1*5 CYWI 4-001307 Reprint of Regulation 14, Section B, as amended persuant to the provisions of the Illinois Unemployment Compensation Act B. Notices to Indicate Possible Ineligibility for Benefits 1. An employing unit shall mail Form UC dll) Ben-22. Notice of Possible Ineligibility, within the time limit and to the address specified by this paragraph, if: a. The worker was discharged for misconduct connected with his work; or b. The worker was discharged because of the commission of a felony or theft in connection with his work, for which the ' employing unit was in no way responsible: or c. The worker left work voluntarily or has been absent for reasons unknown to the employing unit; or d. The worker refused to accept suitable work: or e. During any period which includes the date of the claim or any date subsequent thereto, the worker has been unable to work or unavailable for full-time work: or f. During any period which includes the date of the claim or any date subsequent thereto, the worker has not been unemployed: or g. For any period which includes the date of the claim or any date subsequent thereto, the worker has received or will receive a retirement payment, some or all of the cost of which has been or Is paid by an employing unit for which the worker performed services; or h. During his base period, the worker was paid wages for employment in an instructional, research or principal administra tive capacity performed for an institution of higher education. The employing unit shall mail the Notice of Possible Ineligibility within seven calendar days after the.date of the Form UC I 111) Ben-31, Notice to Last Employing Unit, or of the Form UC fill) Ben-183. Notice of Additional Claim, which has been mailed to it. If it employed the worker during his base period and Form UC (111) Ben-31 or Form UC (ill) Ben-183 has not been mailed to it. the employing unit shall mail the Notice of Possible Ineligibility within seven calendar days after 'he date of the Form UC (111) Ben-305P. Preliminary Notice of Claim to Base Period Employer, which has been mailed to it or. if such form has not been mailed to it, then within >even calendar days after the date of the Form UC (111) Ben-305. Notice of Finding to Base Period Employer, which has beer, mailed to ir. The Notice of Possible Ineligibility shall be mailed :o ::-,e Director at the local office designated on the Form UC illli Ben-31, or Form UC KUl Ben-183, or Form UC (III) Ben-lOoP. or Form UC illli Ben-305, as the case may be. 2. If a worker refuses to accept suitable work after an employing unit has received any notice of the filing of a claim for benefits, the employing unit shall mail Form UC - flit Ben-22. Notice r-f Possible Ineligibility, within seven calendar days after the date of such refusal, to the Director at the local office designated on the form received by the employing unit. 3. Whenever, for any period which includes the dale of his ciaim or any date subsequent thereto, j worker has been or will be paid vacation pay. vacation pay allow ince. pay In lieu of vacation, standby pay. or wages in lieu of nonce, the employing unit shall maii Form UC KID Ben-22. Nonce oi Possible Ineligibility, within seven calendar days after the date of the Form UC illli Ben-31. Nonce to Last Employing Unit, or of (he Form UC i 111) 8en-lS3. Notice of Additional Claim, which has been mailed to it. If it employed the worker during his base penod and Form UC 11111 Ben-31 or Form UC (III) Ben-1 S3 has not been mailed to it. the employing unit shail mail (he Nonce of Possible Ineligibility within seven calendar days after the date of the Form UC i 111) Ben-305P. Preliminary Notice of Claim to Base Period Employer, which has been mailed to :t or. if such form has not been mailed to it. then within -.even calendar days after the date of the Form UC (111) Ben-305. Notice of Finding to Base Period Employer, which has been mailed to it. The employing unit may designate on the Notice of Possible Ineligibility the period to which such payment shall be allocated. The Notice of Possible Ineligibility shall be mailed to the Director at the local office designated on' the Form UC (III) Ben-31, or Form UC (111) Ben-183, or Form UC (III) Ben-305P, or Form UC (111) Ben-305, as the case may be. Whenever the employing unit extends the period to which vacation pay, vacation pay allowance, or pay in lieu of vacation shall be allocated, it shall mail Form UC (111) Ben-22, Notice of Possible Ineligibility, not later than the beginning date of such extension, to the Director at the local office designated on the form which has been mailed to the employing unit. The employing unit may designate on ihe Notice of Possible Ineligibility the beginning and ending dates of the period covered by such extension. 4. Except as specified in Paragraph 5. below, any employing unit which fails to mail Form UC (111) Ben-22. Notice of Possible Ineligibility, to the Director within the time limits and to the office prescribed above shall not be entitled to receive a notice of tire determination of the claims adjudicator which relates to the ineligibility alleged to exist, or to notice of any reconsideration thereof, and it shall not be entitled to prosecute an appeal therefrom to a Referee. The claims adjudicator may, however, use the information disclosed on such form, if any, in making his determination or in a reconsideration thereof, except that a. If an allegation pursuant to Paragraph 1 b, above, is not made within the prescribed time limit, the benefit rights of the worker shall not be canceled; and b. If an allegation that an individual has been or will be paid vacation pay, vacation pay allowance, or pay in lieu of vacation, is not made within the time limits or in the manner prescribed in Paragraph 3, above, or if ihe period to which such payment shail be allocated is not designated as prescribed in the aforesaid paragraph, and the payment is in connection with a separation or layoff of the individual other than for the duration of a shutdown for th,e taking of inventory or for vacation purposes, or both, it shall not be attributed nor be deemed payable to him with respect to any week after such separation or layoff. 5. a. An employing unit to which neither Form UC (111) Ben-31, Notice to Last Employing Unit, nor Form UC (III) Ben-183, Notice of Additonal Claim, not Form UC (111) Ben-305P, Preliminary Notice of Claim to Base Period Employer, nor Form UC (111) Ben-305, Notice of Finding to Base Period Employer, has been mailed, and which mails Form UC (III) Ben-22, Notice of Possible Ineligibility, to the Director at any local office or at 165 North Canal Street, Chicago, Illinois 60606. alleging that the worker is ineligible for benefits for any of the reasons set forth in Paragraphs 1, 2, or 3 above, shall be entitled to receive a notice of the claims adjudicator's determination, or reconsidered determination, if any, which relates to the ineligibility alleged to exist, and shall be entitled to prosecute an appeal therefrom to a Referee, b. An employing unit which, after the time limit prescribed by Paragraph 1. above, mails Form UC (111) Ben-22, Notice of Possible Ineligibility, to the Director at the local office in which the claim is filed, or. if the local office is unknown, to the Director at 165 North Canal Street, Chicago. Illiois 60606, alleging that the worker (1) is unable to work or is unavailable for full-time work, or (2) is not unemployed, or (3) has received or will receive a retirement payment described in Paragraph 1 g, above, shall be entitled to receive a notice of the claims adjudicator's determination, or reconsidered determination, if any, which relates to the ineligibility alleged to exist, but not with respect to any week or weeks which occurred prior to the week in which such form is received. The employing unit shall be entitled to prosecute an appeal to a Referee from such determination or reconsidered determination. 6. An employing unit which, within the time limits and in the manner prescribed by this Regulation, has mailed Form UC (111) Ben-22, Notice of Possible Ineligibility, to the Director, alleging that the worker named thereon (1) is unable to work or is unavailable for full-time work, or (2) is not unemployed, or (3) has received or will receive a retirement payment described in Paragraph 1 g, above, shall be entitled to receive a notice of the claims adjudicator's determination, or reconsidered determi nation, if any, which relates to the ineligibility alleged to exist, and shall be entitled to prosecute an appeal to a Referee from such determination or reconsidered determination, with respect to all weeks for which a'claim is Filed in the calendar year in which the form ia mailed (except as is otherwise provided in Paragraph 5 b, above) and in .the calendar year which immediately follows; except that an employing unit-shall not be so entitled with respect to any week which follows a week in which a determination, or a reconsidered determination, if any, by the claims adjudicator or a decision by the Referee or the Board of Review that the individual is eligible for benefits has been permitted by the employing unit to become final. 7. Whenever Form UC (III) Ben-22, Notice of Possible Ineligibility, is required in accordance with the provisions of this Regulation, the form shall be completed in accordance with the instructions thereon, or a letter giving the information called for on the form may be Filed in lieu thereof. CYWI CONFIDENTIAL in f o r ma t io n r edac t ed CYWI 4-001309 CONFIDENTIAL in f o r ma t io n r edact ed on 33 P5 z O > 2 3 o p) Hz pj H O o> 2r CYWI 4-001311 -Cv " .'A -r . *-- ? <**- ,'r * > --x i , > /.- mu 8 S. SM9KSJ8H0S fWWIL SINKS V CM vD O O c o *-> X; n>; |i ni U> !-;5 'J~-?0 j 9> "*1 1 "c oc>:: o i c/i NJ|_ 0,: L, Cg h-5 -T i Tu . f3 5 - I* - ! |r X~ r V %j iii CYWI 4-001312 f: UlilLLI 8en-134P ' Rev. 10-75) St o c k 4105 STATE OF ILLINOIS - DEPARTMENT OF LABOR 8UREAU OF EMPLOYMENT SECURITY DIVISION OF UNEMPLOYMENT INSURANCE ----- ------------; NOTICE OF CLAIMS ADJUDICATOR'S DETERMINATION^ L made""661'0" s. s. NO. NAME Date. Address all communications regarding this matter to: Division of Unemployment Insurance S024 Illinois 60F0S Ghloago, and refer to this S.S. NO. and Name above *** Claim fr unemPly ment insurance benefits filed by the above named claimant, the following determination has been -mmw cm^n r.t. 4500 Wijf. . 'U CHICAGO, ILL. 60023 JUH i 0 1S77 t Further information is given in the paragraph checked below: l. 'Sf As a party entitled to notice of the claims adjudicator's determination (see reprint of Regulation 14, Section B, on the other side), / your attention is called to Section 800 of the Unemployment Insurance Acf, which provides that "unless the claimant or any other party entitled to notice of the claims adjudicator's... `determination'... within nine (9) calendar days after such notification was mailed to his last known address, files an appeal therefrom, such... `determination' shall be final, as to all parties given notice thereof. '' APPEAL RIGHTS: IF YOU DISAGREE WITH THIS DETERMINATION, You may file an appeal, in person or by mail. Your appeal must be FILED in this office within nine (9) days after the date of this notice if it was mailed to you. or within seven (7) days after the date of.this notice if it was given to you. Any appeal submitted by mail must bear a postmark date within the applicable time limit for filing. A LETTER WILL SUFFICE IF YOU DO NOT HAVE APPEAL FORMS. 2. Your attention is called to Regulation 14, Section B, which is reprinted on the other side of this letter. Our records indicate that you did not submit a Notice of Possible Ineligibility giving the required information for this claimant within the time limit prescribed by ? this regulation. The information you submitted was, however, considered when the above determination was made. This letter is sent to you for information only. Under the provisions of Regulation 14, this information may not be made the basis of an appeal. If you desire any further information concerning this claim, please communicate Witlf'the claims adjudicator at the local office or phone I number given above. . . . ^ ,< j, CYWI 4-001313 B. N,11 vo'i i Reprint of Regulation 14, Section 8t as amended pursuant to the provisions of the Illinois Unemployment Insurance Act I.^iu j 'o P -Nible Ineiigihilir- t Rene:i!N ,:-:i shail lC ' P i ne. i* i!- :In> . m : -in : ;:r.e ii-it :nd * Be I ".v v- -'-J' J1-J ^ ; i'- .'Tipi -.r.-2 : A a" IT H `A j\ r^p' nv^le. i i^ii ->r be.: . "no-,r? hr- w-rk. ! 'r '.vhkF `he I'-v 'a . .s ' :r vs- . i-ir. arilv v h;' Been jb'-nt t -r re.i^e.n^ unkn*"'An : < ! e emph-v :no :;ri,t; . r j. 1 he work-.*: re: j'ed '.o av-.epi suit ible work: or e. During jrn nerii-d vvhkh f.neiuue> [he Jj:e : -he Maim or any date subsequent :!ieret \ :he a >rker has been unable to vu-Bs r uruv.iitable tor :ull-!;me work: or During any period which includes the date of the claim or any Jate subsequent Thereto, the w.-rker \\.\< not been unemployed: or . b' ! Jny period which includes rne date .<( the claim or any date subsequent 'hereto, the worker has received or will reeeoe j retirement payment, some or all ot' the jist of which has been or < paid by an employ.ng unit r`-.*r which the worker performed services: or h, Dunns hw base period, the worker was pa:d wages for employment in an instructional, research or principal administra tive capacity performed for an institution of higher education. The employing unit shall mail the Notice of Possible ineligibility within seven cjlenaar days after the date ot ;he j-orm UC i III) Ben-a I. Notice to Last Employing Unit, or ot the Form UC i III) Ben-1 83, Notice of Additional Claim, which has been mailed to it. If it employed the worker during his base period and Form I'C (!!!) Ben-31 Form UC Mil) Ben-!83 has not Been mailed >o it. the employing unit si-,Ji mail `he Noticeof possible Ineligibility within seven calendar days alter the date r die i"*rm UC t lil) Ben-305P. Preliminary N. rue -t Claim toBase Period Employer, which has been mailed to it or. it such u-rm i i j s not been mailed to it, then within -e'en calendar days after the Jaie of the Form UC i III > Ben-3`>5. Nonce of Finding so Base Period Employer, which has been mailed to it. The Notice of Possible Ineligibility shall be mailed to die Director at the iocjl office designated on the i -rtn UC ill!) Ben-3 I. or Form UC ill!) Ben-1 83. or Form UC i III) Ben-3n5P. or Form UC (ill) Ben-3|l5. a.s ihe case may be. 2. If a wc.-ker -e'u\e> to accept suitable work atter an employing unit has received any notice of the tiling ot a claim tor bene:its. the employing unit shall mail Form UC lit) Ben-23. Nonce o| Possible ineligibility, within seven calendar days after the djte of such refusal. :-> the Director at :!:e !.wa! oi five designated on the form received by the employing unit. 3. Whenever, for any period which includes :he date of his Jjim or any date subsequent thereto, a worker has been or w ill He paid vacation pay. vacation pay allow ance. pay in lieu of v jcation. standby pay. v>r wages in lieu of nonce, the employing unit shall mail Form UC Mil) Ben-22. Notice -u Possible Ineligibility. within seven calendar days after the date of the Form UC Mil) Ben-3 l. Notice to Lj s i Employing Unit, or ;>r rhe I orm UC Mil) Ben-1 83. Notice of Additional Claim, w hich has been mailed to it. If ir employed the worker, during his base period and Form UC MID Ben-31 or Form UCMlii Ben-183 has not been mailed to it. the employ mg unit shaii maii the Notice Possible Ineligibility within seven calendar days after the date ot the Form UC Mil) Ben-305P. Preliminary No nee >r Claimto Base.Period Employer, which has been mailed to u or. if Mkh lour has not been mailed to it. then withm seven Falendar days after ihe date ot the Form UC MU) Ben-305, Notice of Finding to Base Period Employer, which has been mailed to it. The employing unit may designate on the Notice of Possible Ineligibility the period to which such payment shall be allocated. The Notice of Possible Ineligibility shall be mailed to the Director at the local office designated on the Form UC (IU) Ben-31. or Form UC (III) Ben-1 83, or Form UC till) Ben-305P, or Form UC (III) Ben-305, as the case may be. Whenever the employing unit extends the period to which vacation pay, vacation pay allowance, or pay in lieu of vacation shall be allocated, it shall mail Form UC i Hi) Ben-22. Notice of possible Ineligibility, not later than the beginning date of such extension, to the Director at the local office designated on the form which has been mailed to the employing unit. The employing unit may designate on the Notice of Possible Ineligibility the beginning and ending dates of the period covered by 'tich extension. 4. Except a.-, specified in Paragraph 5. below, jny employing unit which fails to mail Form UC Mil) Ben-22, Notice of Possible ineligibility, to the Director within the time limits md to the office prescribed above shall not be entitled to receive a notice of the determination of the claims adjudicator which relate? to the ineligibility alleged to exist, or to notice of any reconsideration thereof, and it shall not be entitled to prosecute an appeal therefrom to a Referee. The claims adjudicator may however, use the information disclosed on Mich form, if any. in making his determination or in a reconsideration thereof, eveept that a. If jn allegation pursuant to Paragraph 1 b. jbove. is not made within the prescribed time limit, the benefit rights of the worker shall not be canceled: and b. If an .-.Beganon that an individual has been or will be paid vacation pay. vacation pay allowance, or pay in lieu of vacation, is not made within the time limits oi in the manner prescribed in Paragraph 3. above, or if the period to which such payment shall be allocated is not designated as prescribed in the aforesaid paragraph, and the payment is In connection with a separation or layoff of the individual other than for the duration of a shutdown for the taking of inventory or for vacation purposes, or both, it shall not be attributed nor be deemed payable to him with respect tc"any week after such separation or layoff. 5. a. An employing unit to which neither Form UC MU) Ben-31. Notice to Last Employing Unit, nor Form UC MU) Ben-183. Notice of Additonal Claim, nor Form UC (Ml) Ben*305P. Preliminary Notice of Claim to Base Period Employer, nor Form UC MID Ben-305, Notice of Finding to Base Period Employer, has been mailed, and which mails Form UC till) Ben-22, Nonce of Possible Ineligibility, to the Director at any local office or at 910 So. Michigan Ave., Chicago, Illinois 60605, alleging that the worker is ineligible for benefits for any of the reasons set forth in Paragraphs 1, 2, or 3 above, shall be entitled to receive a notice of the claims adjudicator's determination, or reconsidered determination, if any, which relates to the ineligibility alleged to exist, and shall be entitled to prosecute an appeal therefrom to a Referee, b. An employing unit which, after the time limit prescribed by Paragraph 1. above, mails Form UC MID Ben-22, Notice of Possible Ineligibility, to the Director at the local office in which the claim is filed, or. if the local office is unknown, to the Director at 910 So, Michigan Ave., Chicago, Illinois 60605. alleging that the worker (!) is unable to work or is unavailable for full-time work, or (2) is not unemployed, or (3) has received or wiU receive a retirement payment described in Paragraph l g. above, shall be entitled to receive a notice of the claims adjudicator's determination, or reconsidered determination, if any, which relates to the ineligibility alleged to exist, but not with respect to any week or weeks which occurred prior to the week in which such form is received. The employing unit shall be entitled to prosecute an appeal to a Referee from such determination or reconsidered determination. 6. An employing unit which, within the time limits and in the manner prescribed by this Regulation, has mailed Form UC (III) Ben-22, Notice of Possible Ineligibility, to the Director, alleging that the worker named thereon (1) is unable to work or is unavailable for full-time work, or (2) is not unemployed,'or (3) has received or will receive a retirement payment described in Paragraph I g. above, shall be entitled to receive a notice of the claims adjudicator's determination, or reconsidered determi nation, if any, which relates to the ineligibility alleged to exist, and shall be entitled to prosecute an appeal to a Referee from such determination or reconsidered determination, with respect to all weeks for which a*claim is filed in the calendar year in which the form is mailed (except as is otherwise provided in Paragraph 5 b, above) and in the calendar year which immediately follows; except that an employing unit shall not be so entitled with respect to any week which follows a week in which a determination, or a reconsidered determination, if any, by the claims adjudicator or a decision by the Referee or the Board of Review that the individual is eligible for benefits has been permitted by the employing unit to become final. 7. Whenever Form UC (HI) Ben-22, Notice of Possible Ineligibility, is required in accordance with the provisions of this Regulation, the form shall be completed in accordance with the instructions thereon, or a letter giving the information called for on the form may be filed in lieu thereof. CYWI 4-001314 INQI S"DE-PARTMENT OF LABOR F EMPLOYMENT SECURITY O LAST EMPLOYING UNIT CLAIM FOR UNEMPLOYMENT REPORT NO: RBIOiOlO LAST DAY I WORKED * REASON FOR UNEMPLOYMENT 12/27/76 LACK OF WORK ------------------------------------------- UI------------------------------------------------ SUB TYPE OF PROGRAM pGM ;CLAIM STATE REG NEW * ./ J .-"ft--* AM ft&tsrf-f' ~'lf *fir r' Af/-^ tr*2 - aFDOd ?( ifA tj[I , Y iE * <; NA 246 HEV. 9*74 3-74 ABSENTEE CALENDAR 1975 a.C COMPANY BUSINESS OOEATh . N FAMILY COOES M.MILITARY oOJl . o F F. r * E-J 9 `NJURY In a m e - - -Oi:OAY iF.-'LUNESS ' N FAMILY p -=e p s o n a l b u s in e s s R - RELIGIOUS j .in j u Py a t ,09 J.j u RY e. w A T L/A..EAVE OF A3SESCE S* SICKNESS TO - TRANSPORTATION DELAY V - V AC A TlON <-u n a u t h o r iz e d DATE EMPLOYED VA-9 /7 JAN JARY TO t a l FEB RUAR>f TO t a l 1 234 MARCH 1 T~o *J U f7 DEPARTMENT t o t al aq senc es f o r y r . <C*C LUDINS h . & v.} TOTAL \ S 6 7 8 9 10 1 1 2 3 4 5 6 7 8 2 3 4 5 6 7 8 T 2 13 14 15 16 17 18 9 to M 12 13 14 15 9 to 11 12 13 1 4 1 5 19 20 21 22 23 24 25 16 17 18 19 20 21 22 16 17 18 19 20 21 22 26 27 28 29 30 31 23 24 25 26 27 28 23 24 25 26 27 28 29 30 31 APR L 67 13 14 20 21 27 TOTAL 1 23 4 8 9 10 11 IS 16 17 18 22 23 24 25 )" MAY S 12 4 5 fi t o t al 12 78 9 19 f rrr 26 18 19 20 21 15 16 22 23 25 26 27 28 29 30 JUNE 31 2 6TOTAL 34 S 10 8 9 11 12 13 W 17 15 16 17 18 19 r20 X 24 22 23 24 25 26 27 31 29 30 7 14 21 28 JULY 67 T 3 14 20 21 27 26 12 a9 ,x 15 16 x 22 29 30 TOTAL 34 10 X" 17 18 24 25 31 AUGUST r 12 X 19 3 10 4 11 26 17 18 24 25 56 12 X X" 19 20 X 26 27 TOTAL t 7a 14 15 21 22 (1 29 31 SEPTEMBER 21 97 a 2 Y' 9 10 TOTAL 45 1! 12 X16 14 1 5 16 18 19 f 2* 23 22 23 25 26 YP30 28 29 6 13 20 27 OCTOBER IT 67 x 13 X X` 19 20 21 X X 22 2826 27 29 TOTAL NOVEMBER 2a X* 9 10 23 X" 16 17 18 9 to 23 24 25 16 V7 30 31 23 24 30 4 X 11 12 18 19 25 if TOTAL 67 13 14 20 21 27 28 DECEMBER 1 a y t X' 89 is 14 15 t 22 l X 1' tX A*29 29 x, 30 TOTAL 345 6 10 11 L. 12 13 t: XX v/ XV \T ll 31 CALENOAR YEAR - 1975 CYWI 4-001317 I CYWI 4-001318 PUBLIC AFFAIRS DIVISION p.yv^ 1^<Z* JZ d--1^ CYWI 4-001319 o X -j z <0C z <t til ^ ^ o$ ru. i Z tia OZ U" CYWI 4-001320 CYWI 4-001321 NO Ui UJ a -l <i 5 ? \J wa ox cf h* O i -J z <O z^ td - Q-- sa Zt CYWI 4-001323 4-001324 CYWI 65Th STREET 1 l--------------------------- -SOUTH CYWI 4-001325 f <ftE OVCflk CLEARING MEDICAL CLINIC 5 3 4 8 W. SSt h St r e e t . C h ic a g o , Il l in o is 6 0 6 3 8 -o S^i w2 2 n2j 'U P O N C O M P L E T IO N ! o ji H a 5 H o z 0a n2 oz a>< >r i O 0 a a oa > IH tSn g n g mo ao > z o r J > r 4 0 Ho z > CYWI 4-001328 \ <r* -*3 >Z (UPON C O M P LE TIO N ) 6 Z wz > * a oK UUzl 5 u 5Id 2 id I- < c a0z. o0 z Q K OQ Z 0 4-001329 CYW1 AM8RICA.V CYA.Va MID COMPACT ANO SUBSIDIARIES RSRSONAL PROTECTION PROGRAM--COMPREHENSIVE Mtainr __ Tr.ozane... ------ James..... . f ir s t n a me MIDDLE INITIAL . F*u it o* Omti Chicago 097 Em.u j Tj . .No , - 400L4-2St1re_et^._LawjidaJje.*._JTi--i.c^aga*_..Lli^.. 60.6Z3- _ia/_u/4s... Da i* Emc l o t c s ..4Z29/26.._....... Sociu, Ssccanr No . Mor.ta Dty Ytf w -- `- oy Yw DEATH BSNSPITS t o BE PAJD TO (zuapi: Mwy A? 6972 a Mxm C Faui S Sureta C ^oevsa Q Mauuxr Q Diroaou GROUP LIFE:. ...Ida... --H.--flr.axton Mo<-haf R<i4UOSj2u9 AdCfttt. 3trw Fim Nam* same Luc Ntma RaUtiaaabip WORK RXi-ATED:__________S oime_ Fim N*m ~ I&iliU UnNiai RaUUoaaLip fir Nmt feudal JUlattooaiup _ Addftaar Street LIST DEPENDENTS ON REVERSE SIDE________________ 57297" 7T Ho.PiSrpn%s: C YA JVA Mll> Your name (print)______ I Plant or Office location..Ch 1C 3 0 Q 097 James Braxton Data uf birth.J WuW`t_lHuiuLuJ\ _12(.<,1 ^4^_______I_f_AH____Ixi Mu Q Female Date ot employmentA p r i 1 2 9 , I 97h- As a contributing member of the Personal Protection Program, I here by elect to enroll in the Cyanamid LONG-TERM DISABILITY INCOME and authorize the Company to deduct the required contributions from my earnings until further notice. J-JLSIGNATURE 4/29/76 CONFIDENTIAL in f o r ma t io n r edac t ed ^ ; It %. .. :~4 Form IL-W-4 ILLINOIS DEPARTMENT OF REVENUE EMPLOYEE'S ILLINOIS WITHHOLDING EXEMPTION CERTIFICATE PRINT PULL NAME Trozone James`Braxton HOME AOORESS 1421 S. Lawndale - , Chicago, TIT, 60&23 EMPLOYEE: HOW TO CLAIM YOURILLINCMS WITHHOLDING EXEMPTION- u ` Fila this form with your employer. Otherwise he must withhold Illinois in come tax from your wages without exemption. 1, Write number of exemption, to which you era ENTITLED on your FMeral Income Tax Return (Form 1040) ................... ' * **r"' , EMPLOYER: Keep this certificate with your records. If the em ployee is believed to have claimed too greet an ex emption, please inform the Illinois Dept, of Revenue. 2. To claim your full Illinois exemption, enter the amount diown on Line 1. If you elect to reduce the amount of your Illinois exemption for purposes of, withholding Illinois income tax, enter a lesser number.. -......... ,`?V.- -' CERTIFY thet the withholding exemption daimed on this certificate does not exceed theatnount to A (LVU3I - 4001336 CYWI 4-001331 V CERTIFIED COPY OP RECORD Of BIRTH T; s i ' ' I*' v-' ' ' ' ' ` I , f! r r a !<ur ' f* !... .r > ! ' ' '> l-r . r i. j. . j1 | i..% 1 lc m c*' 'J `-x* s V my v^noln'C o"`! v.< Jc itt <e,fh<* me 23rd day of Au^-uat 1954. 5 FU A. ; UNCH^.OOD m r . // / : { ij'i Soi.d ^o^'Stror, /' vi MO T -*' r CYWI 4-001332 T 5201 31 01 0 3621 1 H *+ + -i -) t-i O 4-001333 c ywi 637- CYWl 4-001334 EMPLOYEE RELATIONE DEPARTMENT