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SAMPLE
NOTICE TO EMPLOYEE AS TO CHANGE IN RELATIONSHIP
(Issued pursuant to provisions of Section 1089
of the California Unemployment Insurance Code)
Name SSN#
1. You were/will be laid off/discharged on
(date)
20
2. You were/will be on leave of absence starting 20
(date)
3. On _____________employment status changed/will change as follows:
(date)
(Name of Employer)
(By)
