Form Sna-1046a - Monthly Work Activity Report
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3ARIZONA DEPARTMENT OF ECONOMIC SECURITY
Page 1 of 3
SNA-1046A FORFF (12-17)
Workforce Development Administration
Supplemental Nutrition Assistance Employment and Training (SNA E&T) Program
MONTHLY WORK ACTIVITY REPORT
PARTICIPANT NAME (Last, First, M.I.)
JAS ID NUMBER
DUE ON:
SNA E&T SPECIALIST NAME
PHONE NUMBER
FAX NUMBER
EMAIL
PARTICIPATION ACTIVITY HOURS
Write the hours of participation under each appropriate day. If no participation write one of the following: A = ABSENT (Explain in comments) • N = NOT SCHEDULED • H = HOLIDAY
Activity
Sat
Sun
Mon
Tues
Wed
Thurs
Fri
Weekly Totals
WEEK 1
SITE MONITOR’S NAME, SIGNATURE, LOCATION & PHONE NO.
DATE:
Employment
Job Readiness
Education/Training
Homework
TAA
WIOA
Work Experience
Community Service
Submit Application/Resume
Interview
Follow-Up Call/Email
(Check all that apply):
Job Search
Other:
GRAND TOTAL
Did you incur a Transportation Expense?
Yes
No
WEEK 2
SITE MONITOR’S NAME, SIGNATURE, LOCATION & PHONE NO.
DATE:
Employment
Job Readiness
Education/Training
Homework
TAA
WIOA
Work Experience
Community Service
Submit Application/Resume
Interview
Follow-Up Call/Email
(Check all that apply):
Job Search
Other:
GRAND TOTAL
Did you incur a Transportation Expense?
Yes
No
My signature below certifies that the participation hours recorded above are true and correct. I understand that benefits and funds that I receive may depend on my participation in the SNA E&T Program.
Penalties will be applied if I willfully misrepresent this participation information. I understand that I must tell my SNA E&T Specialist if I receive an allowance from any other source for transportation.
SNA E&T PARTICIPANT SIGNATURE
DATE
SNA E&T SPECIALIST APPROVAL
DATE
See page 3 for EOE/ADA/LEP/GINA disclosures
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