Skip to Content

Help | Log Out ( SERGIO MENDEZ )

Certify for Benefits

Payment Activity

Claim History

Form 1099G

Personal Profile

Inbox

Contact Us

Review and Submit Certification

Week 1

Pending Submission

Week 2

Pending Submission

Review and Submit

Confirmation

Review the information below.

For changes or corrections, select the Previous button to return to the previous page.
If the information is correct, follow these steps:
check the Acknowledgement box,
enter your mailing address ZIP Code, and
select the Submit button.
By following these steps, this submission serves as your electronic signature that you answered the certification questions correctly and honestly.
Note: You will NOT be able to change any answers once the Submit button is selected.
*Indicates required field

Summary of Certification Questions and Answers

1.
2.
3.
4.
5.
6.

7.
8.

Were you too sick or injured to work?

1a.If Yes, enter the number of days (1 - 7) you were unable to work.
Was there any reason (other than sickness or injury) that you could not
have accepted full-time work each workday?
Did you look for work?
Did you refuse any work?
Did you begin attending any kind of school or training?
Did you work or earn any money, whether you were paid or not?
6a.Did you receive any other income this week based on work
performed?
If you want federal income tax withheld for the week(s), check the box to
the right.
If you had a change of mailing address or phone number, check the box to
the right.

Week 1
07/24/2016 - 07/30/2016

Week 2
07/31/2016 - 08/06/2016

No

No

No

No

Yes
No
No
No
No

Yes
No
No
No
No

Yes

Yes

No

No

Summary of Work Search Record Week 1: 07/24/2016 - 07/30/2016

Date
Company Name
Applied/Searched

Company Address

Person Contacted

Type of Work
Applied For

07/30/2016

5951 Linea Del Cielo

Rancho Santa Fe, CA 92084
United States

HR N/A

Engineer/Maintenance Waiting on them to reply.

The INN

Results

Summary of Work Search Record Week 2: 07/31/2016 - 08/06/2016

Date
Company Name
Applied/Searched
08/02/2016

Company Address

460 E.Washington Ave

VPM Management Escondido, CA 92025
United States

Person Contacted

Type of Work
Applied For

Results

HR N/A

Apartment
Maintenance

Waiting for a reply .

Acknowledgement
I have read and understand each of the questions, and I have reviewed and agree with the answers to each of the questions I am submitting through this automated
system. I certify that each of the answers is true and correct for this certification period. I know the law provides penalties if I make false statements or withhold facts to
receive benefits. I declare under penalty of perjury that I am a U.S. Citizen or National; or an Alien in satisfactory immigration status and permitted to work by the
United States Citizenship and Immigration Service. I understand when submitting my request for benefits my submission is considered the same as my signature.
*You must indicate your acceptance of the statement by checking the box before your certification can be submitted.

92084

*Enter your mailing address ZIP Code

Previous

Save as Draft

Cancel

Submit

Back to Top

Contact EDD

Conditions of Use

Privacy Policy

Copyright 2014 State of California

Equal Opportunity Notice