Magaca Weydiistaha
LAMBAR AQOONSI (IDENTIFICATION NUMBER)
BYE
PROCESS DATE
LWP
BALANCE
FOOMKA WEYDIISASHADA CAYMISKA SHAQO LA’AANTA
BATCH
MUHIIM:
Haddii magacaaga, adreeskaaga ama lambarka teleefonkaagu is beddelay
ka dib xidhiidhkii ugu dambeeyay ee aad la yeelatay xafiiskayaga, sixidda ku
qor sanduuqa ku yaala midigta.

Magac

Adrees
Haddii magacaaga, adreeska ama teleefonku khaldan
yahay , fadlan sixidda ku qor halkan.
Adrees
Magaalo
Gobol
Furaha Teleefonka
Degmada
Waxa aan weydiisanayaa anfaca shaqo la’aanta todobaadka
(todobaadyada) taariikh-qoraha ee ku dhamaanaya habeenbadh Sabti. TAARIIKHUHU WAA:


1. Maalin shaqo kasta diyaar ma u ahayd shaqo oo ma awoodaysay? (Hadday May tahay, buuxi "A" hoos.)
Sidii laguu sheegay si firfircon shaqo ma u raadsatay oo ciddii aad la xidhiidhay ma ku qortay
2.
Diiwaanka Raadinta Shaqo? (Hadday May tahay, buuxi "A" hoos.)
3. Ma diiday shaqo lagu siin lahaa ama ma ka baaqatay inaad tagtid wareysi shaqo oo ballansan?
(Hadday Haa tahay, buuxi “A” hoos.)
Ma weydiisatay ama ma heshay magdhowga shaqaalaha ama magdhowga dhibane dambe lagula
kacay?
5. Ma weydiisatay ama isbeddel ma ku dhacay lacagta hawlgabka ama benshanka?
4.
(Hadday Haa tahay, buuxi “B” hoos.)
(
Sumad (Zip)
)
TODOBAADKA
KOOWAAD
TODOBAADKA
LABAAD
__________
__________
HAA
MAY HAA

 




 




 




 




 


(Hadday Haa tahay, qor tirada guud ee lacagta oo ah ka hor ka-jarisyada oo buuxi
"C" hoos.)

 
7. Ma heshay lacagta fasaxa?
(Hadday Haa tahay, qor tirada guud ee lacagta oo ah ka hor ka-jarisyada oo buuxi "D"
hoos.)

 

 
Ma heshay lacag beddel u ah ogeysiis ama ma heshay
lacagta shaqo-ka-joojinta?
(Hadday Haa tahay, gali tirada guud ee lacagta oo ah
ka hor ka-jarisyada oo buuxi "E" hoos.)
A
$___________
$___________
$___________

9. Ma shaqeysay? (Hadday Haa tahay, buuxi “F” hoos.)
MAY

6. Ma heshay lacagta ciidda?
8.
PR
ADDR CHANGE?____ LATE?____
Fadlan qor magacaaga oo ah xuruuf kala go’an iyo lambarka aqoonsiga ee
sare. Kama shaqeyn karno weydiisashadaada la’aantiis.
KA JAWAAB KULLI
SU’AALAHA HOOSE
EXT
OFFICE USE ONLY
State of Washington - Employment Security Department
Foomka aad soo buuxisay u soo dir: Spokane UI Claims Center –
CCPU, P.O. Box 14857, Spokane, WA 99214-0857;
faakis degmada ah, 509-893-7240; faakis bilaash ah, 877-280-6224.
WBA

 
$___________
$___________
$___________





Haddii aad "MAY" kaga jawaabtay su’aalaha 1 ama 2, ama "HAA" su’aasha 3, noo sheeg sababta. Bixi faahfaahin. (Ma jirranayd, ma fasax
baad ku jirtay, ma shaqada ayaad ku laabatay, ma goobta shaqada ayaa si weyn kaaga fogeyd?) BIXI TAARIIKHO SAX AH. Sheeg ama sharax
MEESHA (sida goobta shaqada ama goobta dugsiga); AYO baa lug ku lahaa (magaca qofka ku wareystay, magaca dhakhtar, magaca dugsi).
Haddii aad haysid war kale oo aad rumeysan tahay inuu muhiim yahay, fadlan sharax ama soo raaci warka kale.
Sharaxaad: _________________________________________________________________________________________________________
B
Haddii aad "HAA" kaga jawaabtay su’aasha 5, fadlan sheeg warka soo socda ee ku saabsan lacagtaada hawlgabka ama benshanka.
Cidda benshanka ku siisay? _________________________________________; Ma wuxu yahay:  benshan cusub? ama  ma isbeddel
ku dhacay benshan jiray baa?
Tirada lacagta bishii ee cusub ama isbeddel ku dhacay oo ah ka hor ka-jarisyada waa $_______________; Benshanka cusub ama isbeddelay
taariikhda uu bilaabmay waa __________________
C
Haddii aad "HAA" kaga jawaabtay su’aasha 6, u hubso inaad qortid tirada guud ee lacagta ciidda oo ah ka hor ka-jarisyada. Waa kuwee
maalmaha ciidda (ciidaha) ee lacag lagugu siiyay? ________________________; Cidda lacagta ku siisay? _______________________;
Saacadaha lacagta lagugu siiyay?_________________
D
Haddii aad "HAA" kaga jawaabtay su’aasha 7, u hubso inaad qortid tirada guud oo ah ka hor ka-jarisyada. Sababta lacagta fasaxu waa:
 kaash lagugu siiyay wakhti fasax oo aad hore u shaqeysatay, ama  taariikho gaar ah (Haddii lagugu siiyay taariikho gaar ah, waa kuwee
taariikhaha iyo saacaduhu?________________________); Cidda lacagta ku siisay?_______________
E
Haddii aad "HAA" kaga jawaabtay su’aasha 8, u hubso inaad qortid tirada guud oo ah ka hor ka-jarisyada. Waa maxay nooca lacagta lagu
siiyay?___________________ Waa maxay taariikhda (taariikhaha) lagugu siiyay? ____________________; Sababta laguu siiyay?
_____________________________________; Cidda lacagta ku siisay? ________________
– FADLAN AKHRI HADALKA CADEYNTA OO HALKAN SAXEEX KA HOR INTA AANAD SOO CELIN FOOMKAAGA WEYDIISASHADA –
Waxa aan cadeynayaa in dhamaan warka aan ku bixiyay foomkan
ama warqaddan uu sax yahay. Waan ogahay in sharcigu ciqaab
saarayo wixii ah hadal been ah ee lagu daray weydiisashadan.
 ____________________________________________________
SAXEEXA WEYDIISTAHA
1 ee 2

Magaca Weydiistaha
F
LAMBAR AQOONSI (IDENTIFICATION NUMBER)
Haddii aad "HAA" kaga jawaabtay su’aasha 9, fadlan sheeg warka SAACADAHA iyo DAKHLIGA ama lacagta aad ka shaqeysatay shaqo-bixiye
kasta oo aad u shaqeysay.
1. Magaca Shaqo-bixiyaha: ______________________________________ Adrees: _________________________________________
Magaalo: _____________________Gobol: ______ Sumad (Zip): ___________Nooc Shaqo: ________________________________
TIRADA SAACADO EE AAD SHAQEYSAY MAALIN KASTA
TODOBAADKA LABAAD __/__/__
__/__/__ ISKU-DAR DAKHLI
TODOBAADKA KOOWAAD
AX
IS
TA
AR
Haddii aanad shaqo ku qornayn ka dib
todobaadka (todobaadyada) aad weydiisatay
anfaca shaqo la’aanta, sababta sax saar:
KH
JI
SA SAACADO
GUUD
AX
IS
TA
AR
KH
JI
ISU-DAR
SA SAACADO
DAKHLI
GUUD
KA TAGAY; 2 LA ERYAY;
SHAQO MA JIRTO;
9  SHAQO MA JIRTO, SAACADO LA YAREEYAY;
 KALE __________________________
1
5
1. Magaca Shaqo-bixiyaha: ______________________________________ Adrees: _________________________________________
Magaalo: _____________________Gobol: ______ Sumad (Zip): ___________Nooc Shaqo: ________________________________
TIRADA SAACADO EE AAD SHAQEYSAY MAALIN KASTA
__/__/__ ISKU-DAR DAKHLI TODOBAADKA LABAAD __/__/__ ISKU-DAR
TODOBAADKA KOOWAAD
AX
IS
TA
AR
KH
JI
SA
SAACADO
GUUD
AX
IS
TA
AR
KH
JI
SA
SAACADO
Haddii aanad shaqo ku qornayn ka dib
todobaadka (todobaadyada) aad weydiisatay
anfaca shaqo la’aanta, sababta sax saar:
DAKHLI
GUUD
KA TAGAY; 2 LA ERYAY;
SHAQO MA JIRTO;
9  SHAQO MA JIRTO, SAACADO LA YAREEYAY;
 KALE __________________________
1
5
– FADLAN AKHRI HADALKA CADEYNTA OO HALKAN SAXEEX KA HOR INTA AANAD SOO CELIN FOOMKAAGA WEYDIISASHADA –
Waxa aan cadeynayaa in dhamaan warka aan ku bixiyay foomkan
ama warqaddan uu sax yahay. Waan ogahay in sharcigu ciqaab
saarayo wixii ah hadal been ah ee lagu daray weydiisashadan.
 ____________________________________________________
SAXEEXA WEYDIISTAHA
EMS 5325 - SOM (Rev. 12/11) CC 7540-032-167
2 ee 2