WEEKLY WORK SEARCH REPORT FOR _______________________________ SS# ______________________:
UC Week # ____ From Sunday ______________________________ through Saturday ______________________________
Date _______________ Type of Work ___________________________ Result: ____________________________________
Employer Name: _____________________________________ Address __________________________________________
Person Contacted
) ____________________________________________________________________________
(Name/Position
UC Week # ____ From Sunday ______________________________ through Saturday ______________________________
Date _______________ Type of Work ___________________________ Result: ____________________________________
Employer Name: _____________________________________ Address __________________________________________
Person Contacted
) ____________________________________________________________________________
(Name/Position
UC Week # ____ From Sunday ______________________________ through Saturday ______________________________
Date _______________ Type of Work ___________________________ Result: ____________________________________
Employer Name: _____________________________________ Address __________________________________________
Person Contacted
____________________________________________________________________________
(Name/Position)
UC Week # ____ From Sunday ______________________________ through Saturday ______________________________
Date _______________ Type of Work ___________________________ Result: ____________________________________
Employer Name: _____________________________________ Address __________________________________________
Person Contacted
____________________________________________________________________________
(Name/Position)
UC Week # ____ From Sunday ______________________________ through Saturday ______________________________
Date _______________ Type of Work ___________________________ Result: ____________________________________
Employer Name: _____________________________________ Address __________________________________________
Person Contacted
____________________________________________________________________________
(Name/Position)
UC Week # ____ From Sunday ______________________________ through Saturday ______________________________
Date _______________ Type of Work ___________________________ Result: ____________________________________
Employer Name: _____________________________________ Address __________________________________________
Person Contacted
____________________________________________________________________________
(Name/Position)
UC Week # ____ From Sunday ______________________________ through Saturday ______________________________
Date _______________ Type of Work ___________________________ Result: ____________________________________
Employer Name: _____________________________________ Address __________________________________________
Person Contacted
____________________________________________________________________________
(Name/Position)
UC Week # ____ From Sunday ______________________________ through Saturday ______________________________
Date _______________ Type of Work ___________________________ Result: ____________________________________
Employer Name: _____________________________________ Address __________________________________________
Person Contacted
____________________________________________________________________________
(Name/Position)
THIS IS YOUR RECORD. DO NOT ASK ANY EMPLOYER TO SIGN THIS FORM.
UCB-12 TIC (R.05/00)