Fillable Work Search Record Form printable pdf download

Work Search Record Form

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EBWK-10/10

STATE OF RHODE ISLAND

DEPARTMENT OF LABOR AND TRAINING

P.O. Box 20368

CRANSTON, RHODE ISLAND 02920-0944

Phone: (401) 243-9107

Fax: (401) 462-8421 / 462-8443

LAST FOUR OF SSN

Name :

FILL IN YOUR FULL SSN BELOW

Address:

City, State, Zip:

Federal Regulations for the State Extended Benefits (EB) program mandate that evidence of an active work search be provided

weekly since you have applied for or are in receipt of EB payments. You are required to:

1. Complete a work search form that documents three work search contacts for each week that you request benefits:

i) Work search must be conducted on three (3) separate days within the week specified.

ii) netWORKri can serve as one verifiable contact for the specified week.

iii) Individuals using any employment website (i.e. Craig’s List, , etc.) must provide verifiable

information including company name and the specific position for which they have applied. You can also search for

work on the department’s EmployRI network online at https://

iv) NOTE: Trade Union Members are not exempt from the work search while in receipt of EB.

If you are a member in good standing of a trade union (i.e. Local 99 Carpenters’ Union), contacting the union hiring

hall counts as one contact for the week.

v) NOTE: Individuals participating in training programs approved by the department will be exempt from the

work search (i.e. WIA or TRA).

You are advised to keep copies of all your submissions for your personal records.

List three places you looked for work during the week between

and

*****Please see page 2 for an example of a verifiable work search *****

DATE

EMPLOYER

PERSON

POSITION

METHOD OF

RESULTS

ADDRESS

CONTACTED

APPLIED FOR

APPLICATION

I certify that the information provided is accurate:

_______________________________

_________

Claimant’s signature

Date

_________

You must complete, sign, and return this page on

to:

Department of Labor and Training P.O. Box 20368 Cranston, RI 02920-0944

Work Search Record Form

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