Required Form and Method of Filing Requests for Ruling Pursuant to Section 1032.5 o...

(1)

The name, address, telephone number, and employer account number of the employer.

(2)

The claimant's name and social security account number.

(3)

The effective date of the claim (if available).

(4)

Facts disclosing that the claimant is rendering services for the employer in less than full-time work, and that he or she has continuously, commencing in or prior to the beginning of the base period, rendered services for the employer in such less than full-time work.