Form Ncui 506e - Unemployment Insurance - Work Search Record
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3North Carolina Department of Commerce
Division of Employment Security
Unemployment Insurance
Work Search Record
Office Use Only
ATTACH PHOTO ID HERE
Claimant:
SSN: XXX – XX –
Review Date:
Interviewer:
Work Search Requirements: The Employment Security Law, G.S. 96-14.9(e), requires you to be
registered for work
( )
and actively seeking work with a minimum of five contacts with
potential employers for each week you claim. You must keep a detailed record of your work search
activities, which are subject to audit by
DES.
You should maintain these records for at least five (5) years
after you stop filing and return to full-time work. Failure to maintain an adequate and verifiable work
search record for any week claimed may result in a denial, delayed payment, and/or overpayment
(requiring repayment) of benefits.
For instructions on how to make a valid contact please review the Work Search Guidelines included with this form.
Week 1
Beginning Sunday
and Ending Saturday
I did not seek work during this week because:
Dates of Contacts
Employer's Name: Address, Website, E-mail Address or Name & Title of Person Contacted
Contact Method
Position Applied
For
I do solemnly affirm under penalty of perjury, that I am the person named herein, and that the information that I
have provided, including proof of identification and the work search record, is true, correct, and complete to the
best of my knowledge. I further understand that there are severe criminal and civil penalties for providing false
statements and/or willfully misrepresenting any information to increase or receive unemployment insurance
benefits, and that any information I have provided is subject to verification.
Claimant’s Signature
Date
NCUI 506E (Rev 04/2016)
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Parent category: Miscellaneous