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Central Adjudication Unit

Fact-Finding Questionnaires

 

The Department has developed fact finding questionnaires for claimants and employers to expedite the telephone interview with the Central Adjudication Unit. Questionnaires are broken into several categories based on topic. Your adjudication appointment letter may indicate the circumstances that apply to the issue being addressed.

Please complete and return the questionnaire that best fits your situation. You may email the questionnaire as an attachment to DLT.CAUinterview@dlt.ri.gov or fax to 401-462-8318 within 48 hours before the date of your telephone interview or as soon as possible.    

TO FILL OUT QUESTIONAIRES:
  1. Click on the applicable form listed below to open it.
  2. Save the pdf to your computer/devise:
    - In Google Chrome, click the Save icon, or
    - In Firefox, click the menu icon, then the Save Page icon, or
    - In Internet Explorer, click File, then Save As to save the pdf.
  3. Once the pdf file is saved, fill out ALL fields;

  4. Send the filled out document:
    - Print the filled-out pdf, sign it and fax it to 401-462-8318, or
    - Save the file again, attach it to an email and email it to DLT.CAUinterview@dlt.ri.gov.

TO ATTACH A FILE TO AN EMAIL using MS Outlook:
  1. Click New Email in MS Outlook; type DLT.CAUinterview@dlt.ri.gov in the TO line,
  2. Type the date of your telephone interview appointment in the subject line of the email,
  3. Click Attach File (the paper clip) on the main menu,
  4. Go to the place on your computer where you saved the filled pdf and click Insert
  5. Once the pdf file is attached, click Send.

    For instructions on how to attach a file using Outlook, click here.
    For instructions on how to attach a file using Yahoo Mail, click here.
    For instructions on how to attach a file using Hot Mail, click here.








 

Please do not write any information in the body of your email, as the questionnaire will be the only information considered when making a determination on the case.
Any additional information provided in the body of your email will not be reviewed and will be deleted.

If you do not wish to provide a statement, please complete the “Decline to Provide a Statement” form listed below. Please note if you decline to provide a statement, the Department will render a decision based only upon the facts present at the time the determination is made and the department will not contact you for a statement.

If you have already received a decision from the Central Adjudication Unit and would like to appeal your decision online, please click here.

Click the category below that best fits the issue being addressed to access the questionnaires on that topic:

 

 

Decline to Provide a Statement

for Claimants: for Employers:
Decline to Provide a Statement Decline to Provide a Statement

Availability Questionnaires (Questionnaires in this section are for Claimants only):)

Childcare Out of Area
Family Responsibility Personal Vacation
Incarceration Transportation
Leave of Absence Under Medical Care
Minor Under 16 Refusal of Referral from DLT Counselor or EmployRI
Discharge Questionnaires
for Claimants: for Employers:
Suspended (Unpaid) Suspended (Unpaid)
Discharge - Failure to Report Absence Discharge - Failure to Report Absence
Discharge - Absenteeism + Tardiness Discharge - Absenteeism + Tardiness
Discharge - Altercation Discharge - Altercation
Discharge - Away from Work Station Discharge - Away from Work Station
Discharge - Damaging Company Property Discharge - Damaging Company Property
Discharge - Failed Drug Test Discharge - Failed Drug Test
Discharge - Falsify Company Documents Discharge - Falsify Company Documents
Discharge - Involuntary Retirement Discharge - Involuntary Retirement
Discharge - Job Performance Discharge - Job Performance
Discharge - License: Suspension or Loss Discharge - License: Suspension or Loss
Discharge - Other Discharge - Other
Discharge - Refusing Assigned Duties Discharge - Refusing Assigned Duties
Discharge - Refusing Overtime Discharge - Refusing Overtime
Discharge - Sleeping on the Job Discharge - Sleeping on the Job
Discharge - Stealing Discharge - Stealing
Discharge - Unauthorized Use of Company Property Discharge - Unauthorized Use of Company Property
Discharge - Under the Influence of Intoxicants Discharge - Under the Influence of Intoxicants
Pension
for Claimants: for Employers:
Pension - Private or Government Pension - Private or Government
Pension - Military Pension - Military
Refusal of Work
for Claimants: for Employers:
Refusal of Work Refusal of Work
School Employees (for Employers Only)
School Employee - Summer Break or Between Semesters School Employee - School Vacation Period
Voluntary Quits
for Claimants: for Employers:
Voluntary Quit - Accept Other Work Voluntary Quit - Accept Other Work
Voluntary Quit - Attend School or Training Voluntary Quit - Attend School or Training
Voluntary Quit - Care for Ill/Disabled Family Member Voluntary Quit - Care for Ill/Disabled Family Member
Voluntary Quit - Change in Contract or Terms of Hire Voluntary Quit - Change in Contract or Terms of Hire
Voluntary Quit - Child Care Issues Voluntary Quit - Child Care Issues
Voluntary Quit - Company Relocation Voluntary Quit - Company Relocation
Voluntary Quit - Distance to Work Voluntary Quit - Distance to Work
Voluntary Quit - Domestic Violence Voluntary Quit - Domestic Violence
Voluntary Quit - Get Married Voluntary Quit - Get Married
Voluntary Quit - Health/Medical Reasons Voluntary Quit - Health/Medical Reasons
Voluntary Quit - Incarceration Voluntary Quit - Incarceration
Voluntary Quit - Not Paid Correct Amount Voluntary Quit - Not Paid Correct Amount
Voluntary Quit - Other Voluntary Quit - Other
Voluntary Quit - Reduced Work Hours Voluntary Quit - Reduced Work Hours
Voluntary Quit - Relocate - Personal Voluntary Quit - Relocate - Personal
Voluntary Quit - Relocate with Spouse Voluntary Quit - Relocate with Spouse
Voluntary Quit - Retire Voluntary Quit - Retire
Voluntary Quit - Sexual Harassment Voluntary Quit - Sexual Harassment
Voluntary Quit - Sold Business as Owner Voluntary Quit - Sold Business as Owner
Voluntary Quit - Transportation Issues Voluntary Quit - Transportation Issues

 

 

 

 


 

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5/21/19 MDF