LSJE LLC

LSJE LLC 6100 Red Hook Quarter 83 St. Thomas, VI 00802-1348 May 8, 2015 Mr. Angel Feliciano Dear Mr. Feliciano: SI Please be advised that your employment with LSJE, LLC (the "Company") has been terminated, effective May 5, 2015. Your termination is a result of a number of factors, including but not limited to: (1) your repeated absences without proper notice despite warnings and reminders from your supervisors about proper procedure regarding absences; (2) your failure to perform an employment related duty specifically requested multiple times by your supervisor; (3) the improper or careless performance of your employment related duties; (4) hydraulic fluid discovered to have been improperly introduced into inappropriate portions of equipment under your care; and (5) your disregard of explicit directions from your supervisor. We remind you that you signed a confidentiality agreement with the Company, which will remain in full force and effect and with which you are obligated to comply, even though your employment has been terminated. We have enclosed a check in the amount of $1348.82, representing full payment of all outstanding wages due to you through the date of termination. We are making this payment without offset for any damages sustained by the Company as a result of your misconduct with the intention that this will assist in the final termination of our relationship without further issue. Should you not share this intention, please be advised that this payment is without prejudice to any and all rights and claims of the Company against you, all of which are hereby expressly reserved. Sincer t p e Rodri eez Received by:i Angel Feliciano EFTA01221435 JUN. 30. 2015 3:55PM DEPT OF LABOR NO. 5166 P. 1 GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS • DEPARTMENT OF LABOR DIVISION OF UNEMPLOYMENT INSURANCE CLAIMANT: Angel Feliciano EMPLOYER: LSJE, LLC 6100 Red Hook Quarter 8-3 St. Thomas, VI 00802 NOTICE OF HEARING NOTE: The Agency's record will be made part of this hearing. Date of Mailing: June 30, 2015 Determination Date: June 3, 2015 Liable State: VI SSN# Appellant (X) Claimant 0 Employer REFEREE: James W. Kitson Administrative Law Judge Issue: Misconduct APPEAL NO. 061-01-15 You are hereby notified to appear for a hearing on a determination issued by the Virgin Islands Employment Security Agency, St. Thomas, United States Virgin Islands. Please mail two copies of any exhibits before the hearing date, allowing sufficient time for the mail to: James W. Kitson, Administrative Law Judge, Dept. of Labor, Hearings and Appeals • Unit, P.O. Box 302608, Charlotte Amalie, St. Thomas, V.I. 00803 PLEASE BE PROMPT (Please appear in person at the address below) DATE: July 6, 2015 TIME: 12:00 p.m. PLACE: Department of Labor 2353 Kronprindsens Gade St. Thomas, VI 00802 PHONE: Administrative Law Judge If contact cannot be made with the St, iThomas Hearioes& 'Aeneas Unit, please contact. •Itentativelv. St. Croix RearinoS and Appeals at 340:1773-1994. Due to federal guidelines regarding the prompt disposition of appeal cases, postponements can only be granted for emergency reasons. If you are handicapped as defined in Section 405 of the Rehabilitation Act of 1973, please call the department at the above telephone number. PLEASE REFER TO INSTRUCTIONS TO THE CLAIMANT AND EMPLOYER a P.O. Box 789 Christiansted, St. Croix, V.1.00821{ O 4401 Sion Farm Ste. 1, Christiansted, St. Croix, V 0 2353 KronprIndsens Gada, St. Thomas, VI 00802 P.0. K Box 303159, Charlotte Amalie. St. Thomas. V EFTA01221436 JUN. 30. 2015 3:55PM DEPT OF LABOR NO. 5166 P. 2 GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS • DEPARTMENT OF LABOR DIVISION OF UNEMPLOYMENT INSURANCE INSTRUCTIONS TO THE CLAIMANT REASON FOR THIS HEARING: The hearing is being held to give you a chance to present your evidence and your side of the case at or near your place of residence. SUBJECT OF THE HEARING: The hearing will cover the decision listed and may include all questions affecting your right to benefits up to the time of the hearing. APPEARANCE: If you do not appear at the hearing, your appeal may be dismissed or it may be decided on the basis of other available evidence. POSTPONEMENT: This hearing will be postponed only for good cause. Postponement must be requested In writing. If an emergency arises directly prior to scheduled time, and you cannot come to the hearing, notify the place of hearing. (Telephone Number shown on Notice of Hearing) WITNESSES: If you have any witnesses whom you wish to have testify at the hearing, it is your duty to notify them of the TIME and the PLACE of the hearing and arrange for them to be present. REPRESENTATIVES: You may appear at the hearing without representation. However, if you wish, you may be represented by an attorney or anyone else you select. Such attorneys or other authorized agent shall not charge the claimant or receive from him a fee in excess of five percent of the claimant's maximum potential benefits provided for in section 303 (d) of the Act. IF YOU WISH TO WITHDRAW YOUR APPEAL: Send a written request to: Virgin Islands Employment Security Agency, Unemployment Insurance Service, P.O. Box 9650, St. Thomas, Virgin Islands 00801. BRING WITH YOU TO THE HEARING: This notice, all statements, decisions, forms and letters that are connected with your claim; any witnesses whose testimony you need to help you prove your case; all papers and books that are connected with this case. In cases involving health, a doctor's certificate may be important. • P.O. Box 789 Christiansted, St. Croix, V.I. 00821 O 4401 Sion Farm, Sto. 1, Christiansted, Si. Croix, O 2353 Kronprindsens Gade, St. Thomas, VI 0080 O P.O. Box 303159, Charlotte Amalie, St. Thomas, EFTA01221437 JUN. 30. 2015 3:56PM DEPT OF LABOR NO. 5166 P. 3 GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS • DEPARTMENT OF LABOR DIVISION OF UNEMPLOYMENT INSURANCE INSTRUCTIONS TO EMPLOYERS REASON FOR THIS HEARING. This hearing is being held to obtain facts pertinent to the claimant's eligibility for unemployment insurance benefits. SUBJECT OF THE HEARING: The hearing will cover the decision listed below and may include all questions affecting rights to benefits up the time of the hearing. POSTPONEMENT: This hearing will be postponed only for good cause. Postponement must be requested in writing. If an emergency arises directly prior to scheduled time, and you cannot come to the hearing, notify the place of hearing. (Telephone Number shown on Notice of hearing). WITNESSES', If you have any witnesses whom you wish to have testify at the hearing, it is your duty to notify them of the TIME and the PLACE of the hearing and arrange for them to be present. REPRESENTATIVES: You may appear at the hearing without representation. However, if you wish, you may be represented by an attorney or anyone else you select. BRING WITH YOU TO THE HEARING: This notice, all statements, decisions, forms and letters that are connected with this matter; any witnesses whose testimony you need to help you present your case; all papers and books that are connected with this case. K P.O. Box 789 Christiansted, St Croix, V.1.008214340) (340) 773-1994: Fax: (340) 773-0094 K 4401 Sion Farm, Sta. 1, Christiansted, St Croix, V.I. 00820 - (340) 773-1994: Fax: (340) 773-0094 O 2353 Kronprindsens Cade, St Thomas, VI 00802 - (340) 776-3700: Fax: (340)774.5908 O P.O. Box 303169, Charlotte Amalie. St. Thomas, VI 00803 -(340) 778-3700: Fax: 774-5908 EFTA01221438 JUN. 30. 2015 3:56PM DEPT OF LABOR NOTICE Or APPEAL NO. 5166 P. 4 1, NAME 3, if you are planning b Change your oRicem, eomoRto Dv !flowing; Beginning my new address will be a. I appeal and request a hearing for me following reason(s): 1Si 5ckyree • —5rYou - may- atten4- rhearing-In- thts- State- orin - the-State- agalnst— which you arc appealing, in, wNelt State do YOU Olen to attend a hearing? • •• . DeirotiOUTION: Original Duplicate Triplicate Quadruplicate Virgin Islands— 78 Liable State/Transferring State Agent State - Appeals Unit (Attach copy of Determination( Agent State - Local Office Claimant's Copy CLAIMANT: DO NOT WRITE IN IM Box. 6. SOD cl <i il • UCFE 0 UCX 0 ewe 0 OTHER T. LIABLE STATF (A) (0) TRANSPERRINGt STATE tr P. (A) APPEAL FROM: IA A S 0 _Mau 0* . (issue) (1) DaterminatIon 0 (2) Redetermination . in (3) s Decision Wilith we: dated m apt, /mo t( (B). (C) Handed to Claimant (Dated) ( 3) Mailed to Claimant (doStmaric date) 9. APPEAL PILED: (A) laCperson on ---\ -3-4 A--c .(1 )apt.5 (B) 0" Maio (1) Postmark Date (2) Receipt pate 10. STAKER' 'SNAIL/RE a ...... 0 ....- J 1 R USE OF LIABLE STATE 12- LOCAL OPTICS. ADDRESS AND NUMBER (Uso Stable() IR 101 (Juno 1978) EFTA01221439 30.2015 3:56PM DEPT OF LABOR NO. 5166- P. 5- V\../..0 Islands Employment Security Age y Unemployment Insurance Service Type of Claim NOTICE OF NONMONETARY DETERMINATION UI Adj. No. 23 Claimant S. S. No. 1-9220 THIS DETERMINATION IS FINAL UNLESS AN APPEAL IS FILED WITHIN 10 DAYS OF THIS ANGEL L. FELICIANO OR REDETERMINATION LocalOffice 001 Date Wednesday, May 20, 2015 Date Decision is Final Monday, June 01, 2015 Issue Misconduct The following determination has been made on your claim: You are not entitled to unemployment insurance benefits from 05/17/2015: the week in which you left work and beginning with the first day of the week following the week in which the separation occurred until you have worked in at least four subsequent weeks (whether or not consecutive) and earned not less than four REASON FOR DECISION: _ On your intake application form, you selected "lack of work" as the separation reason from your job. It was later noted that you were terminated for a number of factors, as stated by your employer. Some of these factors include your disregard of explicit directions from your superior, and your repeated absences despite several warnings and reminders. Misconduct has been established in this case. Your employer had a right to expect a certain standard of conduct by you that was undisplayed. enefits are denied. This determination is in accordance with Section 304, Subsection b, Paragraph 3 of the Virgin Islands Unemployment Insurance Act as amended on September 3, 1981, September 17, 1982, September 29, 1983, July 30, 1984 and December 19, 1984. NOTICE TO EMPLOYER: This determination is furnished for your information FL — SJ Employees, LLC 6100 Red Hook Quarters, B-3 St. Thomas VI 00802 1348 *Reply to DEPARTMENT OF LABOR UNEMPLOYMENT LNUSRUANCE (For appeal rights see reverse of this notice) virgin Islands Form tUB-fl EFTA01221440 LSJE, LLC Mailing Address: 6100 Red Hook Quarter B3 St. Thomas, VI 00802-1348 General contact information Tel: 340-775-8100 Fax: 340-775-8108 E-mail: Accounts payable department contact information Faxes Employee Name Position. Reek/M C liffirsilVarnffig Employee Warning Notice kiANO Nature of Infraction: I I R ness to Employees or Supervisor I nexcused Absence I I Excessive Absenteeism Lateness/Early Quit Previous Warnings: ORAL WRITTEN, .. DATE BY WHOM Is' Warning IV . "nil / I Peteetedc, rd Warning 3rd Warning Date: Department. / / Second Warning I I Insubordination I I Incompetence I I Neglect of Duty I I Poor Workmanship I / Third Warning I I Abandonment of post I I Conduct Unbecoming I I Abusive Behavior I IOTHER: SUPERVISOR'S DESCRIPTION OF INFRACTION: EMPLOYEE STATEMENT: Dait of I,n Ira ctipn• Ti pi. I I I agree with Employer's statement. I I disagree with Employer's description of the infraction for the following reasons. (...Wifil ti'624-- 8,103;AJ Na- AS 51$006:41 an 14 ltroAti I ft Description of Action to be taken: arning I I Probation I I Suspension I I Dismissal I I Other I have read this Warning Notice and 1 understand it. Signature of Employee Signature of Witness Date Date EFTA01221441 LSJE, LLC Mailing Address: 6100 Red Hook Quarter B3 St. Thomas, VI 00802-134 ntact information Tel: 340-775-8100 Fax: 340-775-8108 E- • • • Accounts payable department contact informatio t Fax: 340-775-2528 Employee Name: Position: /1€ / / First Warning Employee Warning Notice I 12/iciAao Date: Atot Department: • / 0-. cord Warning Nature of Infr • sliont I I Rydeness to Employees or Supervisor I I Insubordination l yl nex sed Absence essive Absenteeism teness/Early Quit Previous Warnings: ORAL WRITTEN DATE BY WHOM I" Warning I 2" Warning 1"------ Viiit I ii PI I Allot-1 Ea r. I 3rd Warning I I I I Incompetence Neglect of Duty I I Poor Workmanship / / Third Warning I I Abandonment of post I I Conduct Unbecoming I I Abusive Behavior I I OTHER : SUPERVISOR'S DESCRIPTION OF INFRACTION: EMPLOYEE STATEMENT: Date Infre tip7 Time- ---- I I I agree with Employer's statement. I I I disagree with Employer's description of the infraction for the following reasons. --t-hs 41 /.3 Ai EX d124/•07 ii€ ha Davtist atom Ato cal/1 Nn Shn I //1 Tate . Description of Action to be taken: timing I I Probation I I Suspension I I Dismissal I have read this Warning Notice and I understand it. Signature of Employee Date Sighatgx of Supervisor I I Other Signature of Witness Date EFTA01221442 LSJE, LLC Mailing Address: 6100 Red Hook Quarter B3 St. Thomas, VI 00802-1348 General contact information Tel: 340-775-8100 Fax: 340-775-8108 E-mail. Accounts payable department contact Information Employee Name. /lid &Le/AND Position: I I First Warning Nature of Infraction; Employee Warning Notice Date: Department. I Second Warning lewd Warning eness to Employees or Supervisor nsubordination I I Abandonment of post cused Absence I I Incompetence I I Conduct Unbecoming I xcessive Absenteeism I I Neglect of Duty I I Abusive Behavior I I Lateness/Early Quit I I Poor Workmanship I I OTHER : Previous Warnings: ORAL WRITTEN DATE BY WHOM Im Warning 2n° Warning 3" Warning t .-- I tiltijd ././ Oe' lam. SUPERVISOR'S DESCRIPTION OF INFRACTION: EMPLOYEE STATEMENT: oDID foor tqfr gtio ( I 0.00/2 on V In) 52 ccze toor LtIouleta04- Tiqe• fitacti op 4O hio Solyd ro‘ Visa- o 44.94 dify s 4th 4.r) woe OR Conic At Description of Action to be taken: I I I agree with Employer's statement. I disagree with Employer's description of the infraction for the following reasons. I arning I Probation I have read this Warning Notice and I understand it. Signature of Employee Signature of Witness Date Date I I Suspension I I Dismissal I I Other EFTA01221443 LSJE, LLC Mailing Address: 6100 Red Hook Quarter B3 St. Thomas, VI 0 - ntact information Tel: 340-775-8100 Fax: 340-775-8108 E- • • Accounts payable department contact information Fax: Employee Name: Position- 1 I First Warning Employee Warning Notice h - c a d o Date: / Department: 1 I Second Warning I / Third Warning Nut u re of Infraction; i I Rutoess to Employees or Supervisor Pir rdination I ii used Absence I ncompetence I .I.Eiccessive Absenteeism I I Neglect of Duty I I Lateness/Early Quit I I Poor Workmanship Previous Warnings: ORAL WRITTEN DATE Y' / / __,.....fi y. M -s*Car ( --- -- ,,„,„,„ 2i0 Warning III q 3rd Warning IS IS I /21 jer I I Abandonment of post I Conduct Unbecoming I I Abusive Behavior OTHER: bovE3 WR14;41 1/45 SUPERVISOR'S DESCRIPTION OF INFRACTION: EMPLOYEE STATEMENT: Datnoif Infra:520 n: Time:_e_ I I I agree with Employer's statement. I I I disagree with Employer's description of the infraction for the following reasons. . pirabiar Foca, tattathisia, s eine/ <7/ 0 r I Aga:VA' 6 ritlh II/Dr.htity WAS p ‘4117. Description of Action to be taken: I Warning I I Probation I I Suspension I Other I have read this Warning Notice and I understand it. Signature of Employee Signature of Witness Date r) Date EFTA01221444 LSJE, LLC Mailing Address: 6100 Red Hook Quarter B3 St. Thomas, VI 00802-1348 General contact information Tel: 340-775-8100 Fax: 340-775-8108 E-mail: Accounts payable department contact information Fax: Finnlo)ee Name: Employee Warnin Notice I fi litiAnt Position: I I First Warning Nature of Infraction: I I Rudeness to Employees or Supervisor I I Insu rdination I I Unexcused Absence I I I Excessive Absenteeism c nee Ipecac Duty I I Lateness/Early Quit Iskroor Workmanship Previous Warnings: ORAL WRITTEN DATE BY WHOM 10 Warning 1 2id Warning 3s Warning Department: Date: I / Second Warning I I Third Warning I I Abandonment of post I I Conduct Unbecoming I I Abusive Behavior I IOTHER: SUPERVISOR'S DESCRIPTION OF INFRACTION: EMPLOYEE STATEMENT: D e of 4:fraction Time. I I I agree with Employer's statement. I I I disagree with Employer's description of the infraction for the following reasons. tif i) ;t1S WAHP ArI lilt h ir tro g • °Mk,- St - , iti) v_ .5/m4d its4 A' 'tuft CHAR ;Mod y 9 v ' • It T ail, Aim i s MCAP+ clik i4- F , r will Le4- him33o. No No 5 6/5/13 Description of Action to be taken: I I Warning r I Probation I I Suspension I Ittirnissal f I Other I have read this Warning Notice and I understand it. H Signature of Employee Signatureof Witn Date Date Si `Supervisror Date EFTA01221445 LSJE, LLC Mailing Address: 6100 Red Hook Quarter B3 St. Thomas, VI 00802-1348 General contact information Tel: 340-775-8100 Fax: 340-7754108 E-mail: Accounts payable department contact information Employee Name: 4 Position: anie I I First Warning Employee Warning Notice rclin;44O Department: Date: 5/346 I I Second Warning / / Third Warning Nature of Infraction: I Rudeness to Employees or Supervisor I I Insubordination I I Unexcused Absence I I Incompetence Excessive Absenteeism I I Neglect of Duty I I Lateness/Early Quit I I Poor Workmanship Previous Warnings: ORAL WRITTEN DATE BY WHOM la Warning Ps Warning 3rd Warning I I Abandonment of post I I Conduct Unbecoming I I Abusive Beh)viir I OTHER : OW4 SUPERVISOR'S DESCRIPTION OF INFRACTION: EMPLOYEE STATEMENT: of In r cti n• Time. I I I agree uith Employer's statement. I I I disagree with Employer's description of the infraction for the following reasons. ld dLj our #r atm Description of Action to be taken: I I Warning I Probation I I Suspension IKCnissal I Other I have read this Warning Notice and I understand it. Signature of Employee S# 1Cide_ gnature of Date Date EFTA01221446 This iS to cerli.Iy that /11-- f has been inkier 111\ Irt` 10, Return: • I L----t-v4 c. (-\--()- (4, 44.6 Signature: EFTA01221447 < Messages (6) Angel -LSJ Details Text Message Wed, Apr 8, 8:53 AM 4( Call mi En,Apr -10,7:16AM Please call me or Danny next time if your calling out sick, late or whatever. Thank you, Anna Mon, Apr 13, 6:10 AM Dentist appointment today Tue, Apr14-, i 1: 10 AM Send EFTA01221448 No call, no show again. I'm not sure what's going on? I think you should call by 12pm if you would like to keep your job. Boat captain not your Supervisor Danny or Manager. *You texted me you have a Dentist Appointment EFTA01221449 .900o AT8,- 7:59 AM 81% OD All Missed Angel #2 LSJ (3) mobile Carlos- LSJ mobile Angel -LSJ (2) mobile BOBO -LSJ mobile Carlos- LSJ mobile Karl mobile Antonio/Chico mobile Moon (3) mobile Yr. , .1,i) 000 000 000 Edit 0 0 o_cP Recents Contacts Keypad Wk.:email EFTA01221450 *No call, No show Friday 4/10/2015 You called the Boat captain not your Supervisor Danny or Manager. *You texted me you have a Dentist Appointment Monday 4/13/2015 *No call, No show Tuesday 4/14/2015 *No call, No show Wednesday 4/15/15 No call, no show again. I'm not sure what's going on? I think you should call by 12pm if xini i ‘Arni ilrl hien +n 1 e nnr-, EFTA01221451 < Messag s (6) Angel #2 LSJ Detai McindaY4/13/2015 *No call, No show Tuesday 4/14/2015 *No call, No show Wednesday 4/15/15 No call, no show again. I'm not sure what's going on? I think you should call by 12pm if you would like to keep your job. This is insubordination. Wednesday 7:28 AM Mon you left early. Tues No call, No show Wednesday No call, No show. Send EFTA01221452 gin Islands Employment Security AL ,cy Unemployment Insurance Service Type of Claim NOTICE OF NONMONETARY DETERMINATION UI OR REDETERMINATION Adj. No. 23 Claimant S. S. No. ANGEL L. FELICIANO RECEIVED MAY 2 2015 LocalOffice 0CII_. THIS DETERMINATION IS FINAL UNLESS AN APPEAL IS FILED WITHIN 10 DAYS OF THIS Date Wednesday, May 20, 2015 Date Decision is Final Monday, June 01, 2015 Issue Misconduct The following determination has been made on your claim: You are not entitled to unemployment insurance benefits from 05/17/2015, the week in which you left work and beginning with the first day of the week following the week in which the separation occurred until you have worked in at least four subsequent weeks (whether or not consecutive) and earned not less than four REASON FOR DECISION: On your intake application form, you selected "lack of work" as the separation reason from your job. It was later noted that you were terminated for a number of factors, as stated by your employer. Some of these factors include your disregard of explicit directions from your superior, and your repeated absences despite several warnings and reminders. Misconduct has been established in this case. Your employer had a right to expect a certain standard of conduct by you that was undisplayed. Benefits are denied. This determination is in accordance with Section 304, Subsection b, Paragraph 3 of the Virgin Islands Unemployment Insurance Act as amended on September 3, 1981, September 17, 1982, September 29, 1983, July 30, 1984 and December 19, 1984. NOTICE TO EMPLOYER: This determination is furnished for your information Rs, Employees, LLC 6100 Red Hook Quarters, B-3 St. Thomas VI 00802 1348 1 Reply to DEPARTMENT OF LABOR UNEMPLOYMENT INUSRUANCE (For appeal rights see reverse of this notice) Virgin Islands Fenn UIB-53 EFTA01221453 SECTION 304 of the Virgin Island, . nemployment Insurance Act as ame. ed September 3, 1981, September 17, 1982, September 29, 1983, December 12, 1983, July 30, 1984 and December 19, 1984, provides: (b) An insured worker shall not be disqualified for waiting-week credit or benefits for any week of his unemployment unless with respect to such week the Commissioner fmds that: (3) he was discharged for misconduct connected with his most recent work, in which case he shall be disqualified for the week in which he was discharged and beginning with the first day of the week following the week in which he was discharged until he has worked in at least four subsequent weeks (whether or not consecutive) and earned not less than four times his weekly benefit amount. § 305. Determinations, notices, and payment of benefits—Payment of benefits Notice by employing unit (c) An employing unit having knowledge of any facts which may affect an individual's right to waiting- week credit or benefits shall notify the Director of such facts promptly, in accordance with regulations prescribed by the Commissioner of Labor. (3) The last employing unit which employed a claimant shall be entitled to receive written notice of a determination only if it has furnished information to the Commissioner in accordance with subsection (c) of this section prior to such determination. Finality of determination (f) A determination shall be deemed final unless a party entitled to notice thereof applies for reconsideration of the determination or appeals therefrom within 10 days after the notice was mailed to his last known address or otherwise delivered to him; Provided, that such period may be extended for good cause. A party entitled to notice of a determination may, within the aforesaid time limits, at his option, appeal from such determination without first applying for reconsideration thereof. APPEAL RIGHTS If you do not agree with this determination, you are entitled to file a request for reconsideration or an appeal within ten (10) calendar days from the date of this notice. Your request should be filed in person or in writing through your local claims office. LOCAL OFFICE ADDRESSES ST. THOMAS/ST. JOHN Physical Address: Department of Labor Unemployment Insurance Division 2353 Kronprindsens Gade St. Thomas, USVI Mailing Address: PO Box 303159 St. Thomas, VI 00803 Telephone Number: (340) 776-3700 Fax Number: (340)714-4995 Physical Address: Department of Labor Unemployment Insurance Division 4401 Sion Farm Christiansted, St. Croix USVI ST. CROIX Telephone Number: (340)773-1994 Fax Number: (340)773-1515 Hours are: 8:00 AM - 5:00 PM Monday through Friday EFTA01221454 • Date: 05-11.2015 Virgin Islands Department of Labor Vice of Unemployment Insurance Compen on Request for Separation Information Please answer the following questions and return to the Local Office (listed below) by: This claimant applied for Unemployment Insurance Benefits on Employee's Name: ANGEL L. FELICIANO Employer's Name & Address: 18125 LSJE, LLC 6100 RED HOOK QUARTER 8-3 CHARLOTTE AMALIE, VI 00802 Due Date: 05-20-2015 05-20-2015 05.11.2015 and named you as their last employer: Employee's SSN: NOTE: The Law provides penalties for false statements. REASON FOR SEPARATION [ Discharged ) Lack of Work / Layoff [ ] Leave of Absence [ J Other (are there any other reasons for separation?) 1 J Labor Dispute ( ) Voluntary Quit Submit additional facts that may affect the claimant's rights to benefits on the reverse side of this form. If this form is returned and you have indicated facts that may affect this person's eligibility for benefits, you will be notified In writing of the Agency's decision. Sce rcvcrxf REPORTED SEPARATION EARNINGS Since the last day worked, has the claimant received, or will he/she receive one of the following: . 1. Pension or any other retirement payment? If yes, please indicate effective date and amount: $ per month amount -or- 2. Severance or any other separation earnings? If yes, please indicate type of pay and amount: [ ) Severance $ [ 1 Vacation f ] Other 3. Please indicate the following from your records: First Day Worked ir/ "S .0 obi Last Day Worked NOTICE OF INTERVIEW [ J YES No Effective Date: $ [ ] YES (1(N0 lump sum pension amount lump sum severance amount S lump sum vacation amount lump sum other amount If the claimant's reason for separation Is other than "lack of work", the claimant will be scheduled for a Fact Finding Interview on at the local office listed below. You will be contacted if additional information is required. RETURN COMPLETED FORM TO: VI Department of Labor Division of Unemployment Insurance P.O. Box 303159 Charlotte Amalie, VI 00803-3159 Li Rove, Cher Printed N e 3hto- 7 7 - 25 ..25 Phone Number Date Signed • EFTA01221455 Virgin Islands Department Of Labor Office Of Unemployment Insurance Compensation Notice Of Potential Liability Employer Id: 18125 LSJE, LLC 6100 RED HOOK QUARTER B-3 CHARLOTTE AMALIE, VI 00802 Dear Employer, RECEnitf) MAY .18 2015 05-11-2015 This is to notify you that ANGEL L. FELICIANO (Social Security Numbe , has fled a claim for unemployment benefits. According to our records, you paid this person the following wages: Year/Quarter Wages Paid 2014-1 $0.00 2014-2 $0.00 2014-3 $0.00 2014-4 $6,160.00 Total Wages $6,160.00 Your Account will be charged with 20 percent of the benefits, if any, because the total wages above represent that percentage of all benefit wages. If you feel you are being charged in error, please explain on the reverse side of this letter and return it to: VI Department of Labor Division of Unemployment Insurance P.O. Box 303159 Charlotte Amalie, VI 00803 -3159 (340) 776-3700 Thank You for your attention in this matter, Chief Of Benefits 1/IDOL- UI Compensation EFTA01221456