Fact-Finding Questionnaires (adjudication) The Department has developed fact finding questionnaires for claimants and employers to expedite the telephone interview with the Central Adjudication Unit. Questionnaires are broken into several categories based on topic. Your adjudication appointment letter may indicate the circumstances that apply to the issue being addressed. Please complete and return the questionnaire that best fits your situation. You may email the questionnaire as an attachment to DLT.CAUinterview@dlt.ri.gov or fax to (401) 462-8318 within 48 hours before the date of your telephone interview or as soon as possible. If you do not wish to provide a statement, please complete the Decline to Provide a Statement Form. Please note if you decline to provide a statement, the Department will render a decision based only upon the facts present at the time the determination is made and the department will not contact you for a statement. For Claimants Decline to Provide a Statement Decline to Provide a Statement PDF file, less than 1mbmegabytes Availability Questionnaires Childcare PDF file, less than 1mbmegabytes Out of Area PDF file, less than 1mbmegabytes Family Responsibility PDF file, less than 1mbmegabytes Personal Vacation PDF file, less than 1mbmegabytes Incarceration PDF file, less than 1mbmegabytes Transportation PDF file, less than 1mbmegabytes Leave of Absence PDF file, less than 1mbmegabytes Under Medical Care PDF file, less than 1mbmegabytes Minor Under 16 PDF file, less than 1mbmegabytes Refusal of Referral from DLT Counselor or EmployRI PDF file, less than 1mbmegabytes Discharge Questionnaires Suspended (Unpaid) PDF file, less than 1mbmegabytes Failure to Report Absence PDF file, less than 1mbmegabytes Absenteeism & Tardiness PDF file, less than 1mbmegabytes Altercation PDF file, less than 1mbmegabytes Away from Work Station PDF file, less than 1mbmegabytes Damaging Company Property PDF file, less than 1mbmegabytes Failed Drug Test PDF file, less than 1mbmegabytes Falsify Company Documents PDF file, less than 1mbmegabytes Involuntary Retirement PDF file, less than 1mbmegabytes Job Performance PDF file, less than 1mbmegabytes License: Suspension or Loss PDF file, less than 1mbmegabytes Other Discharge PDF file, less than 1mbmegabytes Refusing Assigned Duties PDF file, less than 1mbmegabytes Refusing Overtime PDF file, less than 1mbmegabytes Sleeping on the Job PDF file, less than 1mbmegabytes Stealing PDF file, less than 1mbmegabytes Unauthorized Use of Company Property PDF file, less than 1mbmegabytes Under the Influence of Intoxicants PDF file, less than 1mbmegabytes Pension Private or Government PDF file, less than 1mbmegabytes Military PDF file, less than 1mbmegabytes Refusal of Work Refusal of Work PDF file, less than 1mbmegabytes Voluntary Quits Accept Other Work PDF file, less than 1mbmegabytes Attend School or Training PDF file, less than 1mbmegabytes Care for Ill or Disabled Family Member PDF file, less than 1mbmegabytes Change in Contract or Terms of Hire PDF file, less than 1mbmegabytes Child Care Issues PDF file, less than 1mbmegabytes Company Relocation PDF file, less than 1mbmegabytes Distance to Work PDF file, less than 1mbmegabytes Domestic Violence PDF file, less than 1mbmegabytes Got Married PDF file, less than 1mbmegabytes Health or Medical Reasons PDF file, less than 1mbmegabytes Incarceration Voluntary Quit PDF file, less than 1mbmegabytes Reduced Work Hours PDF file, less than 1mbmegabytes Relocate Personal PDF file, less than 1mbmegabytes Relocate with Spouse PDF file, less than 1mbmegabytes Retire PDF file, less than 1mbmegabytes Sexual Harassment PDF file, less than 1mbmegabytes Sold Business as Owner PDF file, less than 1mbmegabytes Transportation Issues PDF file, less than 1mbmegabytes For Employers Decline to Provide a Statement Decline to Provide a Statement (Employer) PDF file, less than 1mbmegabytes Discharged Questionnaries Suspended Unpaid (Employer) PDF file, less than 1mbmegabytes Stealing (Employer) PDF file, less than 1mbmegabytes Unauthorized Use of Company Property (Employer) PDF file, less than 1mbmegabytes Under the Influence of Intoxicants (Employer) PDF file, less than 1mbmegabytes Absenteeism & Tardiness (Employer) PDF file, less than 1mbmegabytes Failure to Report Absence (Employer) PDF file, less than 1mbmegabytes Altercation (Employer) PDF file, less than 1mbmegabytes Away from Work Station (Employer) PDF file, less than 1mbmegabytes Damaging Company Property (Employer) PDF file, less than 1mbmegabytes Failed Drug Test (Employer) PDF file, less than 1mbmegabytes Falsify Company Documents (Employer) PDF file, less than 1mbmegabytes Involuntary Retirement (Employer) PDF file, less than 1mbmegabytes Job Performance (Employer) PDF file, less than 1mbmegabytes License: Suspension or Loss (Employer) PDF file, less than 1mbmegabytes Other Discharge (Employer) PDF file, less than 1mbmegabytes Refusing Overtime (Employer) PDF file, less than 1mbmegabytes Refusing Assigned Duties (Employer) PDF file, less than 1mbmegabytes Sleeping on the Job (Employer) PDF file, less than 1mbmegabytes Pension Private or Government (Employer) PDF file, less than 1mbmegabytes Military (Employer) PDF file, less than 1mbmegabytes Refusal of Work Refusal of Work (Employer) PDF file, less than 1mbmegabytes School Employees Summer Break or Between Semesters (Employer) PDF file, less than 1mbmegabytes School Vacation Period (Employer) PDF file, less than 1mbmegabytes Voluntary Quits Accept Other Work (Employer) PDF file, less than 1mbmegabytes Attend School or Training (Employer) PDF file, less than 1mbmegabytes Care for Ill or Disabled Family Member (Employer) PDF file, less than 1mbmegabytes Change in Contract or Terms of Hire (Employer) PDF file, less than 1mbmegabytes Child Care Issues (Employer) PDF file, less than 1mbmegabytes Company Relocation (Employer) PDF file, less than 1mbmegabytes Distance to Work (Employer) PDF file, less than 1mbmegabytes Domestic Violence (Employer) PDF file, less than 1mbmegabytes Got Married (Employer) PDF file, less than 1mbmegabytes Health or Medical Reasons (Employer) PDF file, less than 1mbmegabytes Incarceration Voluntary Quit (Employer) PDF file, less than 1mbmegabytes Not Paid Correct Amount (Employer) PDF file, less than 1mbmegabytes Other Voluntary Quit (Employer) PDF file, less than 1mbmegabytes Relocate Personal (Employer) PDF file, less than 1mbmegabytes Relocate with Spouse (Employer) PDF file, less than 1mbmegabytes Reduced Work Hours (Employer) PDF file, less than 1mbmegabytes Involuntary Retirement (Employer) PDF file, less than 1mbmegabytes Sexual Harassment (Employer) PDF file, less than 1mbmegabytes Sold Business as Owner (Employer) PDF file, less than 1mbmegabytes Transportation Issues (Employer) PDF file, less than 1mbmegabytes