1 Start 2 Complete Employer name * Contact name * Phone number * Address for primary location: * Country * United States Address 1 * Address 2 City * State * - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming--Armed Forces (Americas)Armed Forces (Europe, Canada, Middle East, Africa)Armed Forces (Pacific)American SamoaFederated States of MicronesiaGuamMarshall IslandsNorthern Mariana IslandsPalauPuerto RicoVirgin Islands ZIP code * Email address * Are other locations affected? yes no Additional locations affected * Is there a reduction in force due to: * closure layoff furlough (temporary layoff) Date of layoff (or first possible date of layoff if there may be multiple dates) * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year2018201920202021202220232024 Number of affected workers * Do workers have bumping rights? * yes no Are workers represented by union(s)? * yes no If yes, name of union(s) and union representative name and contact information Choose industry: * Manufacturing IT Retail Logistics Hospitality (travel, hotel, restaurant & entertainment) Service Industry Construction Health Care Other If other, please specify: Is the closure/layoff due in part to COVID-19? * Yes - we had less demand for our products/services due to COVID-19 Yes - we have an excess of inventory due to COVID-19 Yes - other No - this decision is unrelated to the COVID-19 pandemic If yes, other, please specify: Would you like to answer some additional questions to see if your workers are eligible to receive "trade" benefits? * Yes No If the decision to lay off workers was affected by foreign competition or movement of business to a foreign country, the workers may be eligible to receive additional “trade” benefits. a. Does your company do business in other countries? Yes No b. Has your company recently been sold or purchased by another company that does the same or similar type of work? Yes No c. Do you compete with other companies that produce similar or like products or services? Yes No d. Do you receive a product or service from another company in order to produce your product or service or does another company rely on your product or service to finish their product or service? Yes No Leave this field blank
