Sample Application: Add U.S. Military Employment

Note: If you are not physically present in Washington at the moment you are attempting to file a claim for unemployment benefits based on your military wages, you cannot file a Washington claim. You must file against the state in which you are physically present.

Are you physically in the State of Washington at this time?

Yes No

Have you filed an unemployment compensation claim since your most recent separation from active military service?

Yes No

If you answer "yes", an additional field will appear:
State:

Branch of Service:

What is the member copy number on your DD-214?

Pay Grade (Item 4.b):

Entry Date (Item 12.a) (mm dd yyyy):

___________ ___________ ___________

Separation Date (Item 12.b) (mm dd yyyy):

___________ ___________ ___________

Chracter of Service (Item 24):

Days Accrued Leave Paid:

___________

Do you have dates of Time Lost?

Yes No

If you answer "yes" six additional fields will appear:

From: ___________ To: ___________

Have you applied for or are you receiving a Pension from this employer?

Yes No

Are you receiving or have you applied for Vocational Rehabilitation Allowance?

Yes No

Are you receiving or have you applied for War Orphan's/Widow's Educational Allowance?

Yes No

Your wages based on military service will not be added to your claim until we receive a copy of your DD214 (any Member copy, 2 through 8) or we receive a response from your branch of service. You will be given the mailing address and FAX number when you actually file your claim.