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NMON-2000
Notification of Separation / Refusal of Work
*
Required Information
1.
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Claimant SSN
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-
2.
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Claimant First Name
3.
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Claimant Last Name
4.
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Are you reporting a separation issue?
Yes
No
If Yes, provide the separation information
a. Separation Reason
-Select-
Designated Vacation
Discharge/Fired
Labor Dispute/Strike
Leave of Absence
Suspension
Voluntary Quit
-Select-
Designated Vacation
Discharge/Fired
Labor Dispute/Strike
Leave of Absence
Suspension
Voluntary Quit
b. Separation Date
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/
c. Separation Details
(Must not exceed 256 characters.)
5.
*
Are you reporting a Refusal of work?
Yes
No
a. If Yes, provide the date of refusal
/
/
6.
*
Employer Information
a. Mississippi Employer Account Number
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b. Submitter Name
c. Submitter Title
d. Phone
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