State of Illinois
Department of Employment Security
www.ides.illinois.gov
Work Search Record
Claimant Information:
Last Name: First Name: MI:
ID or SSN:
(Este es un documento importante. Si usted necesita un intérprete, póngase en contacto con su oficina local.)
Instructions: Please use this form to keep a record of the work search efforts you made. Be sure that all requested
information is provided. Failure to do so may result in a denial of benefits. If you need additional pages, contact your local
office or duplicate this form.
Important Notice: Keep Your Work Search Records
A determination that you were actively seeking work during a week being claimed is subject to reconsideration despite the fact
that you have been paid benefits or returned to work. In order to preserve evidence that you were actively seeking work, do
not discard your written work search record for any week being claimed until 53 weeks have passed from the end of that week.
Further, if there is an appeal pending regarding your active work search for a week, keep your written work search record until
there has been a final resolution of the matter.
Week Ending
Contact
Date
Name & Address of Contact Person Contacted Method of
Contact
Type of Work
Sou
ht
Results
Week Ending
Results
Contact
Date
Name & Address of Contact Person Contacted Method of
Contact
Type of Work
Sou
ht
ADJ034F Page 1 of 2 TCS-2 Rev. (09/2011)
Click here for the Work Search Explanation.
