Fillable Division of Employment Security Unemployment Insurance Work Search Record (North Carolina)

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Division of Employment Security Unemployment Insurance Work Search Record (North Carolina)

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North Carolina Department of Commerce
Division of Employment Security
Unemployment Insurance
Work Search Record
Claimant:
SSN: XXX – XX –
Review Date:
Interviewer:
Work Search Requirements: The Employment Security Law, G.S. 96-14.9(e), requires you to be
registered for work
(www.ncworks.gov) and actively seeking work with a minimum of three contacts with
potential employers for each
week you claim. You must keep a detailed record of your work search
activities, which are subject to audit by DES.
You should maintain these records for at least five (5) years. Failure to maintain an adequate and verifiable work
search record for any week claimed may result in a denial, delay, and/or overpayment of benefits.
For instructions on how to make a valid contact please review the Work Search Guidelines included with this form.
Week # __
Beginning Sunday
and Ending Saturday
Date of
Contact
Company Contacted
Contact Method
In person (I)
Telephone (T)
*Email (E)
*Online (O)
Fax (F)
Provide name of contact (if applicable)
AND
one (1) of the following based on
contact method:
Physical Address
Telephone Number
Email Address
Website Address
Fax Number
Position Seeking
(Ex. Not Hiring,
Submitted Application,
Interview,
Second Interview,
*Attach a copy of confirmation email or confirmation number for any online contacts.
I do solemnly affirm under penalty of perjury, that I am the person named herein, and that the information that I have
provided, including proof of identification and the work search record, is true, correct, and complete to the best of my
knowledge. I further understand that there are severe criminal and civil penalties for providing false statements and/or
willfully misrepresenting any information to increase or receive unemployment insurance benefits, and that any
information I have provided is subject to verification.
NC CLM 506E (Rev 12/2019)
Claimant’s Signature
Date
Office Use Only
ATTACH PHOTO ID HERE
Claimant: SSN: XXX – XX –
Week # __
Beginning Sunday
and Ending Saturday
Date of
Contact
Company Contacted
Contact Method
In person (I)
Telephone (T)
*Email (E)
*Online (O)
Fax (F)
Provide name of contact (if applicable)
AND
one (1) of the following based on
contact method:
Physical Address
Telephone Number
Email Address
Website Address
Fax Number
Position Seeking
(Ex. Not Hiring,
Submitted Application,
Interview,
Second Interview,
*Attach a copy of confirmation email or confirmation number for any online contacts.
Week # __
Beginning Sunday
and Ending Saturday
Date of
Contact
Company Contacted
Contact Method
In person (I)
Telephone (T)
*Email (E)
*Online (O)
Fax (F)
Provide name of contact (if applicable)
AND
one (1) of the following based on
contact method:
Physical Address
Telephone Number
Email Address
Website Address
Fax Number
Position Seeking
(Ex. Not Hiring,
Submitted Application,
Interview,
Second Interview,
*Attach a copy of confirmation email or confirmation number for any online contacts.
Week # __
Beginning Sunday
and Ending Saturday
Date of
Contact
Company Contacted
Contact Method
In person (I)
Telephone (T)
*Email (E)
*Online (O)
Fax (F)
Provide name of contact (if applicable)
AND
one (1) of the following based on
contact method:
Physical Address
Telephone Number
Email Address
Website Address
Fax Number
Position Seeking
(Ex. Not Hiring,
Submitted Application,
Interview,
Second Interview,
*Attach a copy of confirmation email or confirmation number for any online contacts.
Week # __
Beginning Sunday
and Ending Saturday
Date of
Contact
Company Contacted
Contact Method
In person (I)
Telephone (T)
*Email (E)
*Online (O)
Fax (F)
Provide name of contact (if applicable)
AND
one (1) of the following based on
contact method:
Physical Address
Telephone Number
Email Address
Website Address
Fax Number
Position Seeking
(Ex. Not Hiring,
Submitted Application,
Interview,
Second Interview,
*Attach a copy of confirmation email or confirmation number for any online contacts.
NC CLM 506E (Rev 12/2019)
Work Search Guidelines
REQUIREMENTS OF A VALID CONTACT
You must complete a work search for each week you claim unemployment insurance benefits including your waiting
period week. DES will only consider contacts with employers who have a position matching your qualifications,
knowledge, ability, or skill. Employer contact must be for the sole purpose of obtaining employment.
Your work search record MUST Include:
(1) Date of contact
(2) Company contacted
(3) Contact method
(4) Name of contact (if applicable) and based upon contact method provide website address, e-mail address, fax number,
*If you are using an employment website, provide the name of the employer you are applying for a position with AND the
name of the employment website.
(5) Position seeking
(6) Results
Contacti
ng the same employer regarding the same position or opening more than once during the same week can only
count as one employer contact unless you are at different stages of the hiring process. (i.e. interview, second interview).
ACCEPTABLE METHODS OF CONTACT
• SUBMIT APPLICATION OR RESUME, LETTER OF INTEREST, ETC. - through Employer or Employment Website
(including NC Works)
• TELEPHONE CONVERSATION with Employer – Message left on voicemail or answering service is NOT sufficient
• IN-PERSON MEETING with Employer – May include contacts at job fairs or similar events or video interviews
• INITIAL REGISTRATION via NCWorks.gov (only applies for week registration was completed)
• BLIND ADVERTISEMENT (An online or newspaper ad that does not give the company name) - A copy of a blind
advertisement may substitute for employer name, name of contact, and job title. You must keep a copy of the
advertisement for your records
Below is an example of valid work search contacts
Week # _1_
Beginning Sunday 07/29/2018
and Ending Saturday 08/04/2018
Date of
Contact
Company Contacted
Contact Method
In person (I)
Telephone (T)
*Email (E)
*Online (O)
Fax (F)
Provide name of contact (if applicable)
AND one (1) of the following based on
contact method:
Physical Address
Telephone Number
Email Address
Website Address
Fax Number
Position Seeking
Results
(Ex. Not Hiring,
Submitted Application,
Interview,
Second Interview,
Submitted Resume)
07/31/2018
Al's Plumbing
I
Alfonso Johnson, 123 Main Street
Plumber
Not hiring
Burlington, NC 27215
08/01/2018
Barbara's Baleru
T
Barbara Bodreaux
Baker
Second Interview
336-123-4567
08/02/2018
Carla's Accounting
E
Jane Smith
Accountant
Submitted
Application
carla123@yahoo.com
*Attach a copy of confirmation email or confirmation number for any online contacts.
Week # _2_
Beginning Sunday 08/05/2018
and Ending Saturday 08/11/2018
08/06/2018
Dollar Tree
O
www.dollartree.com
Cashier
Resume submitted
online
08/09/2018
Blind Advertisement
F
919-896-8956
Customer Service Rep
Resume submitted
by fax
***Remember to maintain a copy of the
advertisement for your records
NC CLM 506G (Rev 12/2019)
telephone number, or physical address
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Division of Employment Security Unemployment Insurance Work Search Record (North Carolina)

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Completed 19 August 2020

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