Contact Phone
Resume:
WORK SEARCH RECORD
WORK SEARCH RECORD FOR WEEK BEGINNING SUNDAY THROUGH SATURDAY
To be eligible for UC benefits, complete the work search record below. Refer to your Pennsylvania UC Handbook (Form UCP-1) for complete instructions or open the UC Work
Search Requirement Guide.
If you are working part-time, and earning more than your Partial Benefit Credit, initial here
JOB APPLICATIONS/INTERVIEWS WORK SEARCH ACTIVITY
#1 Date of Application or Date of Interview Date of Activity
Employer Type of Activity
Employer Contact Name
Employer Phone/Email Location of Activity
How did you apply for the job Contact Name
Results Contact Phone/Email
#2 Date of Application or Date of Interview Date of Activity
Employer Type of Activity
Employer Contact Name
Employer Phone/Email Location of Activity
How did you apply for the job Contact Name
Results Contact Phone/Email
#3 Date of Application or Date of Interview Date of Activity
Employer Type of Activity
Employer Contact Name
Employer Phone/Email Location of Activity
How did you apply for the job Contact Name
Results Contact Phone/Email
EXEMPTION Employer/Hiring Hall Name Contact Name Contact Phone/Email
Written Date of Recall (attach copy)
Union Hiring Hall
I certify that all information I have provided in this document is correct and complete. I acknowledge that false statements in this document are punishable pursuant to
18 Pa.C.S. §4904, relating to unsworn falsification to authorities.
First Name M.I. Last Name Social Security Number XXX-XX- __ __ __ __ (last 4 digits)
Signature Date
Su M Tu W Th F Sa
A person who knowingly makes a false statement or knowingly withholds information to obtain UC benefits commits a criminal offense under Section 801 of the UC Law, 43
1
P.S. §871, and may be subject to a fine, imprisonment, restitution and loss of future benefits.
Date
2345678
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