Fillable REEMPLOYMENT ASSISTANCE EMPLOYER REPORTING REFUSAL OF SUITABLE WORK (South Dakota DLR)

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REEMPLOYMENT ASSISTANCE EMPLOYER REPORTING REFUSAL OF SUITABLE WORK (South Dakota DLR)

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South Dakota Department of Labor & Regulation (DLRA) aim to promote economic opportunity and financial security in the South Dakota. They support individuals and businesses through expert services, employment solutions and business practices.

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DLR RA 400 – Recall and Refusal REV 05/2020
SOUTH DAKOTA DEPARTMENT OF LABOR AND REGULATION
REEMPLOYMENT ASSISTANCE
EMPLOYER
REPORTING REFUSAL OF SUITABLE WORK
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Submit to RAFraud@state.sd.us or mail to DLR RA Division, ATTN Benefits, P.O. Box 4730, Aberdeen, SD, 57402
Your business name: ______________________________________________________________
Full name of the individual: ___________________________________________ Last four digits of their SSN:_________
Was the individual laid off due to COVID19 or other reasons?
COVID reasons Other reasons, please explain: ______________________________________________
Was the individual given a recall date? Yes No If yes, what was the recall date? ____________
How was the individual contacted to return to work? (check all that apply)
o Email
o Phone Call
o Text Message
o In person
o Other (please describe below)
Provide the contact information you used to make the offer of work and any other details about the contact. If offer
made by phone, include whether the individual was spoken to directly.
What details were given to the individual about their return to work?
What was the individual’s response? Be specific.
YOUR CONTACT INFORMATION
Name__________________________________________________________ Date completed form______________
Contact number_________________________ Contact email _____________________________________________
Submit to RAFraud@state.sd.us or mail to DLR RA Division, ATTN Benefits, P.O. Box 4730, Aberdeen, SD, 57402
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REEMPLOYMENT ASSISTANCE EMPLOYER REPORTING REFUSAL OF SUITABLE WORK (South Dakota DLR)

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Completed 21 August 2020

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