Workr Umbrella employee request to be furloughed If you are currently out of work because of the circumstances created by the Coronavirus outbreak and wish to be considered to be furloughed (if that is an option) then please complete this form so we can consider that request. 1. Claim datesThe first date I was unable to go to work due to the Coronavirus outbreak was:* DD slash MM slash YYYY If you have since returned to work or know when that will be please select the first date of that new assignment. If that is unknown then please leave blank: DD slash MM slash YYYY 2. Reason for requestI wish to be considered for furlough because: My assignment was cut short because of the Coronavirus outbreak* Yes No Assignment and assignment end proof*Please upload evidence such as copy of your contract showing the original finish date and any written confirmation from your Agency that the assignment was ended early due to Coronavirus. Drop files here or Select files Max. file size: 64 MB. My assignment ended when it was meant to but I can’t renew it or find a new one because of the Coronavirus outbreak* Yes No Assignment and assignment end proof*Please upload evidence such as written confirmation from your Agency that they do not have further work for you due to Coronavirus. Drop files here or Select files Max. file size: 64 MB. My assignment ended for another reason* Yes No If your assignment ended for any other reason, please detail the reason as fully as possible below:*3. Your recruitment agency detailsRecruitment Agency* Recruitment Agency Contact Person* Recruitment Agency Contact Person Email Address* 4. Your details and confirmationName* First Last NI number* Email* Confirmation* I confirm I have read the FAQs, wish to request to be furloughed, have completed this form accurately and have provided supporting evidence where asked to do so.