P.O.
Box 9046, Olympia, WA 98507
Date: Nov 30 2020
54000002-000794-01-00000000
Letter ID: L0029382067
Claimant ID: KNBFN7
DEVAN MOLIGA 2ND
4306 S 124TH ST
TUKWILA WA 98178-3445
Data Sharing Notice
In order to help you return to work, get training or prepare for a new career, we work with other government
and private community-service organizations as partners in the statewide WorkSource system. To serve you,
we share some of your personal information with our WorkSource partners. Our partners vary depending on
where you live and the services that are available in your area.
What are some examples of partners?
• Area contractors for the federal Workforce The Department of Social and Health Services
•
Innovation and Opportunity Act (WIOA) Community and Technical Colleges
•
• Local Workforce Development Boards Specifically authorized community-service
•
organizations
Can the information be shared with anyone besides partners?
No. Your information can only be shared with partners inside the WorkSource system or as permitted by law1
What information do we share?
• Name • Veteran status • Work history, including
• Address (mail and email) • Disability status employer, employer address,
• Social Security number • Race occupation, job title, salary,
• Birth date • Legal entitlement to work in the U.S. start and end dates of
• Phone number • Primary language employment, average hours
• Gender • UI claimant status, including Effective worked, and reason for
• Highest education level attained Date of Claim and Benefit Year End leaving the last employer
Search more than 60,000 Washington jobs on [Link]. Visit WorkSource for free employment workshops and expert
job-hunting advice.
Read the Handbook for Unemployed Workers at [Link] to find everything you need to know about benefits, including training
for a new career.
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DATA SHARING NOTICE
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How will your information be used to help you get another job?
54000002-000794-02-00000000
We and our partners may use the information to:
• Match you to known job openings or future jobs in demand based on your education, work
history, and wages.
• Based on possible eligibility, refer you to WorkSource programs that require you, for example,
to be a veteran, low income, basic skills deficient, or a dislocated worker.
• Find out what jobs are in demand or in decline in your area.
• Help you develop a customized re-employment plan based on your personal and professional
background.
• Ensure you have language interpretation and translation assistance, if needed
What if I do not want my information shared with WorkSource partners?
If you don’t want your information automatically shared with partners for employment and training
services, please complete and return this form. Choosing not to share your personal information
won’t affect your eligibility for unemployment insurance benefits or other services we provide.
What if I change my mind and want to share my information so I can participate in other services?
If you change your mind, you will need to visit a WorkSource office in person with photo ID and
ask to have your data sharing status changed.
I don’t want my information automatically shared with WorkSource partners.
Date ______________________ Social Security number ___________________
Printed name _______________ Signature ______________________________
E-mail a scanned version of this completed form to optout@[Link] or mail it to:
Employment Security Department
Attn: Data Sharing Opt-Out
P.O. Box 9046
Olympia, WA 98507-9046
Please do not send unemployment claims-related documents such as questionnaires to the above
email box or physical address; it may delay the processing of your claim.
If you have questions about this form contact your local WorkSource office. To find the nearest
location visit [Link].
Search more than 60,000 Washington jobs on [Link]. Visit WorkSource for free employment workshops and expert
job-hunting advice.
Read the Handbook for Unemployed Workers at [Link] to find everything you need to know about benefits, including training
for a new career.
L0029382067
DATA SHARING NOTICE
Page: 2 of 3
1The uses of confidential UI claimant data held by the Employment Security Department are governed by
RCW 50.13.
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Search more than 60,000 Washington jobs on [Link]. Visit WorkSource for free employment workshops and expert
job-hunting advice.
Read the Handbook for Unemployed Workers at [Link] to find everything you need to know about benefits, including training
for a new career.
L0029382067
DATA SHARING NOTICE
Page: 3 of 3