Employment Insurance Questionnaire

An employment insurance questionnaire is a tool which helps to know if a person needs insurance or not. Employment insurance is a monthly payment made by the government to a person who has lost his job. It is a temporary form of financial assistance provided to employees who have been laid off for no fault of theirs, while they use the time to look for another job or upgrade their skills.

Sample Employment Insurance Questionnaire:

Name: _______________________

Address: ___________

Date of birth: _________

Gender: ____________

Phone Number: ________________

Email Address: _______________

Marital Status: __________

Social security number ________

Mother’s maiden name: _________

1)   Please give the name and address of the organisation you were working at previously? ___________

2)   How long did you work there? ______

3)   When did you lose your job? _________

4)   Where you given any reason why you lost your job or why you quit? __________

5)   Where there any days in the past 52 weeks when you did not work or receive payment? If yes, please give details. ________

6)   Please mention the dates and salary before deductions in the last 52 weeks. _______

7)   Have you got any other payment like severance pay, pension etc in lieu of notice? _______

8)   Have you been provided with records of employment by your previous workplace? _____

9)   Are you applying for sickness benefits? Please provide medical certificate.

10)               Please give your details about your bank account:

a)   Name of bank:

b)   Name of bank branch:

c)   Address of bank:

d)   Bank account number:

Category: Employment Questionnaire

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