Healthways Services Work Search Log - Cal Investments, Inc.
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1Healthways Services - Work Search Log
Name: ___________________________________________________
Week of:
___________________ to ______________________
Social Security #: _________ - ________ - _________
Number of Required searches: ____________________________
Please make as many copies of this form as needed.
Date, Description of Work Search
Name, Location and Telephone Number of
Contact Information
Results
(Ex: Applied for job, submitted resume, attended job fair,
Employer / Service / Agency
Complete all that apply.
interviewed, used Workforce Center searched online)
(For address, use street or Internet address)
__Hired
__Not hiring
Name
Person Contacted
Date of Activity
Start date
Address
__By Mail
(Enter Address at left)
Work Search Activity
City, State, Zip Code
__E-Mail
__Application filed
Type of Job
Area Code + Phone # (
)
__Fax # (
)
__Other
__Hired
__Not hiring
Person Contacted
Name
Date of Activity
Start date
__By Mail
Address
(Enter Address at left)
Work Search Activity
__Application filed
__E-Mail
City, State, Zip Code
Type of Job
__Other
__Fax # (
)
Area Code + Phone # (
)
Person Contacted
__Hired
__Not hiring
Name
Date of Activity
__By Mail
Start date
Address
(Enter Address at left)
Work Search Activity
__E-Mail
__Application filed
City, State, Zip Code
Type of Job
__Fax # (
)
__Other
Area Code + Phone # (
)
__Hired
__Not hiring
Person Contacted
Name
Date of Activity
Start date
__By Mail
Address
(Enter Address at left)
Work Search Activity
__Application filed
__E-Mail
City, State, Zip Code
Type of Job
__Other
__Fax # (
)
Area Code + Phone # (
)
Person Contacted
__Hired
__Not hiring
Name
Date of Activity
__By Mail
Start date
Address
(Enter Address at left)
Work Search Activity
__E-Mail
__Application filed
City, State, Zip Code
Type of Job
__Fax # (
__Other
Area Code + Phone # (
)
)
Keep this form for your records. Send a copy to Healthways Services only if requested by using the address or fax number provided.
CAL Investments, Inc.
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