Unemployment Insurance Constituent Service
By filling out this form, you are giving Delegate Levine's staff permission to share your information with the Virginia Employment Commission.
First Name *
Last Name *
Email Address *
Phone Number (please use the same phone number you used when applying for unemployment and/or PUA) *
Last Four Digits of Social Security Number *
Have you filed for UI and/or PUA online at the VEC website? *
If yes, what type?
Clear selection
Have you received a monetary determination from the VEC? *
What is your reason for unemployment? *
If other, provide more information:
Have you been filing weekly claims on the VEC website or though the 1-800 number? *
Are you self-employed, a gig worker, a 1099 filer, or independent contractor? *
Have you received UI benefits in the last twelve months? *
Have you exhausted your unemployment benefits? *
Have you been told there is an issue on your claim? YES or NO, and if YES please briefly explain. *
Have you had contact with another legislative office on this matter? *
If you have had contact with another legislative office about this, which one?
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy