Form Ub-101-A - Work Search Log
Download a blank fillable Form Ub-101-A - Work Search Log in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Ub-101-A - Work Search Log with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2UB-101-A (4-17)
ARIZONA DEPARTMENT OF ECONOMIC SECURITY
WORK SEARCH LOG
from (the begining date of your UI claim)
(WORK SEARCH LISTED IS SUBJECT TO VERIFICATION BY THE DEPARTMENT AT ANY TIME)
RECORD ALL JOBS SEARCHES. INCLUDES BUT ARE NOT LIMITED TO RESUMES SENT, INTERVIEWING, IN-PERSON INQUIRIES AND NETWORKING.
PLEASE BRING YOUR WORK SEARCH LOG(S) WITH YOU TO YOUR INTERVIEWS. MAKE ADDITIONAL COPIES OR USE PLAIN PAPER AS NEEDED.
CLAIMANT’S NAME (Last, First, M.I.)
SOCIAL SECURITY NUMBER
TYPE OF
NAME AND ADDRESS
PHONE
NAME OF PERSON
TYPE OF WORK
RESULTS /
DATE
(Number, Street, City, State, ZIP Code)
CONTACT
NUMBER
CONTACTED
SOUGHT
COMMENTS
OF EMPLOYER CONTACTED
CERTIFICATION
I have answered these questions for the purpose of obtaining Unemployment Insurance. I understand that the law provides penalties for making false statments.
CLAIMANT’S SIGNATURE
DATE
DEPUTY’S SIGNATURE
DATE
Equal Opportunity Employer/Program • Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, the
Age Discrimination Act of 1975, and Title II of the Genetic Information Nondiscrimination Act (GINA) of 2008; the Department prohibits discrimination in admissions, programs, services, activities, or employment
based on race, color, religion, sex, national origin, age, disability, genetics and retaliation. The Department must make a reasonable accommodation to allow a person with a disability to take part in a program,
service, or activity. Auxiliary aids and services are available upon request to individuals with disabilities. To request this document in alternative format or for further information about this policy, contact your local
office; TTY/TDD Services: 7-1-1. • Free language assistance for DES services is available upon request. • Disponible en español en línea o en la oficina local.
Spanish on reverse
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal