Fillable (Use Sunday date) (New York State)

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(Use Sunday date) (New York State)

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WS 5 (01/ 22) Equal Opportunity Program - Auxiliary aids and services are available upon request to individuals with disabilities Page 1 of 2
Work Search Record For Week Ending: _____/______/________
(Use Sunday date)
Last Name: _________________________________ First Name______________________ NYS ID#: NY_______________ or SS No: XXX-XX-__________
(Found at the top of appointment letters) (Last four digits only)
This f orm may be used to record your work search activities. Instructions are on the back. You can also use the Work Search Record on our JobZone website instead
of this form. Simply click on the JobZone Work Search link when you claim weekly Unemployment Insurance benefits online. You must show at least three work
search activities for each week that you claim benefits. Please make sure the below charts show at least three separate entries or that you record three separate
activities per week on JobZone.
Businesses/Employers Contacted: List jobs you have applied for, interviews you have attended, and businesses/employers you have contacted during the
week shown above
. All columns should be filled in, to the best of your ability. Use additional sheets of paper if needed. The f irst row is an example.
Date
of
contact
Position
applied
for
Business/Em ployer
name
Name and title
of person
contacted
(if known)
Method
of contact
(In person, phone, fax,
email, web site, etc.)
Contact information for
method of contact listed
(address, teleph one number,
email, website/URL, fax
number)
Result of contact
(if known)
(Interview, waiting for
response, not hired)
1/2/2014 Clerk ABC In dustries
John Smith,
HR Director email j.smith@abcin c.com Set up interview
Other Work Search Activities: List things you did to find a job that were not business/employer contacts. See Instructions on the back for suggested activities. The first row is an example.
Date of activity
Activity performed
1/3/2014 Attended a resume preparation workshop at the Career Center
WS 5 (01/ 22) Equal Opportunity Program - Auxiliary aids and services are available upon request to individuals with disabilities Page 2 of 2
New York State Department of Labor
Work Search Record Instructions
You must actively look for work while claiming Unemployment Insurance benefits. You must keep a Work Search Record for each week you claim
benefits and be prepared to give a copy of that Record to the New York State Department of Labor when requested. We will check the information on
the form with the contacts listed. If you knowingly give us false statements about your work search activities, it is considered f raud and you may be
denied Unemployment Insurance benefits.
You must do at least three work search activities each week, unless you have a Work Search Plan approved by the Department of Labor.*
You are encouraged to do more.
Work Search Activities: Work search activities may include, but are not limited to:
(1) Use employment resources available at a local Career Center or
through a virtual career center platform provided by the
Department of Labor. Examples include:
(i) meet with Career Center advisors;
(ii) receive job market information from Career Center staff about
jobs in your industry or region;
(iii) complete skills assessments for job matching;
(iv) attend instructional workshops; and
(v) get job referrals from the Career Center and follow up with
employers.
(2) Submit job applications or resumes to employers or former
employers who may have openings.
(3) Attend job search seminars, career networking meetings, job fairs,
or employment-related workshops that offer job-search skills
instruction.
(4) Interview with employers.
(5) Register for, apply f or, or take job-related or pre-hire tests for a
public or private employer. This includes civil service exams.
(6) Register and follow up with private employment agencies,
placement services, unions, and placement offices of schools,
colleges, or universities, or professional organizations.
(7) Use the telephone, business directories, internet, social media, or
online job matching systems to search for jobs, get leads, request
referrals, or make appointments for job interviews.
(8) Any other reasonable activity that may help you become
employed.
Keep copies of your Work Search Records for one year. Do not
send your Work Search Record to the Department of Labor unless
we ask you to. You can get more f orms at your local New York
State Career Center, online at www.labor.ny.gov
or in your
claimant handbook. You may also keep your work search record
online at
www.jobzone.ny.gov.
*If you have a Work Search Plan approved by the Department of
Labor, you must do what was agreed upon in the plan and record
those activities on the Work Search Record. We will check your
Work Search Record to be sure you are doing what is called for
in your Work Search Plan.
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(Use Sunday date) (New York State)

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Completed 21 April 2022

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