Maryland Division of Unemployment Insurance
1100 N. Eutaw St., Baltimore, MD 21201
You must make three (3) job contacts for each week that you file a continued claim (request for payment) by Webcert or Telecert. (El formulario en espanol es solamente para demostracion, tiene
que completar y regresar el formulario en INGLES). You should retain this record in case your work search is audited. Making false statements may lead to a finding of unemployment insurance fraud.
Date
Mo/Day/Yr
Employer Name, Address, Phone Number,
E-mail Address or Website
How Contacted
Person Contacted
and Title
Type of
Work Sought
Results
Application
or Resume
submitted?
E-mail or
Website
Confirmation
Number
Always submit applications, unless the employer specifically says they aren't accepting any at that time.
Work-Search Notes:
1.
Keep copies of email or website confirmations in either paper or electronic form.
2.
Attempt to contact people with hiring authority when seeking work.
3.
4.
Reading newspaper, bulletin board, or website job listings do not constitute a valid "job contact". You must apply for a specific job.
Website
E-mail
Mail
Phone/Fax
In Person
Hired
Pending
Not Hiring
No
Yes
Phone/Fax
Mail
E-mail
Website
In Person
Phone/Fax
Mail
E-mail
Website
In Person
Pending
Hired
Not Hiring
No
Yes
Pending
Hired
Not Hiring
No
Yes
Website
E-mail
Mail
Phone/Fax
In Person
Hired
Pending
Not Hiring
No
Yes
Phone/Fax
Mail
E-mail
Website
In Person
Website
E-mail
Mail
Phone/Fax
In Person
Not Hiring
Hired
Pending
Yes
No
Hired
Pending
Not Hiring
No
Yes
Save Form
Print Form
Reset Form
