Application for Unemployment Assistance

Please use this form only if you were NOT formerly employed by United or Lane Furniture. If you were laid off from United/Lane, please go back and fill out the United/Lane Employee Assistance application. Thank you!
Before starting the application, please gather the following documentation that you will need to upload into this form:
  1. Your photo ID
  2. Documentation that you have registered with MDES for unemployment
  3. The electric bill for which you are applying for assistance

Previous Employment

Please provide information for your most recent employment.
Date of Last Employment
Assistance is available only for individuals who became unemployed on or after November 1, 2022.

Personal Information

Please answer these questions for yourself or the person requesting the assistance.
Spouse/Partner Name, if applicable


Uploaded files must be less than 8 MB. If your file is too large to attach, you can try a couple of things: 1. Save the document as a lower-quality or low-resolution file 2. If the file is a photo, try cropping it to make the overall file smaller. If you still have trouble, please call us at 662-841-9133.
Drop files here or
Max. file size: 8 MB.
    Drop files here or
    Max. file size: 8 MB.
      Even if you do not have a current balance due, please upload your most recent electric bill.
      Drop files here or
      Max. file size: 8 MB.


        Consent and Confirmation(Required)