Instructions

Job Search Log
NAME: George S. Hernandez ID: 882035373 1
Keep this document for your records
INSTRUCTIONS: Please use dark ink only. Keep this Job Search Log for your records - do not send it to us unless we ask for it. You must complete this log for each week you claim unemployment benefits. You must have a combined total of three employer contacts or approved job-search activities each week. You can get more logs at your local WorkSource office or online at www.esd.wa.gov/job-search-log. If you apply online or respond to a newspaper ad, please attach a copy of the confirmation notice or ad. Refer to your Unemployment Claims Kit for further instructions on completing this log. If we select you for an interview to review your job search activities, please bring proof of your identity. We may review your logs any time up to 60 days past the end of your benefit year or up to 30 days after receiving any benefits, whichever is later. We may call the employers listed to verify that you looked for work. Providing false information is fraud that can result in a denial of your unemployment benefits and additional penalties.
Employer contacts and job search activities

Date of contact M/D/Y Business name with mailing address or web address, or WorkSource office
Business/WorkSource office name
How contact was made (Include phone number, complete email address, or confirmation for all contacts) In person Online Phone: () Fax: () Email: In person Online Phone: () Fax: () Email: In person Online Phone: () Fax: () Other
Contact name or position, or job reference number or confirmation notice
Type of contact (Include position applied for or name of approved WorkSource activity if applicable) Application / resume Interview Inquiry
CONTACT 1
Street, P.O. box or web address
WorkSource activity
City, state
CONTACT 2
Other
Application / resume Interview
Inquiry
WorkSource activity
Other
CONTACT 3
Inquiry
WorkSource activity
Other Application / resume Interview Inquiry
Email: CONTACT 4
In person Online Phone: () Fax: ()
WorkSource activity
Other

Fax: () Email: In person Online Phone: ()
CONTACT 5
Inquiry
WorkSource activity

Fax: () Email: In person Online Phone: () Other
Application / resume Interview Inquiry
CONTACT 6
WorkSource activity
Email: Week being verified Reschedule WS office name or # TeleCenter # Staff initials
The Employment Security Department is an equal opportunity employer and provider of programs and services. Auxiliary aids and services are available upon request to persons with disabilities. Auxiliary aids may include qualified interpreters and telecommunication devices (TTY) for hearing or speech impaired individuals. Individuals with limited English proficiency may request EMS 10313 . CC 7540-032-823 . Rev 4/11
For official use only
NAME: ...............................................................................................
Date of contact M/D/Y CONTACT 7 Business name with mailing address or web address, or WorkSource office
Business/WorkSource office name
ID: ..................................................................
How contact was made (Include phone number, complete email address, or confirmation for all contacts) In person Online Phone: () Fax: () Email: In person Online Phone: () Fax: () Email: In person Online Phone: () Fax: () Email: In person Online Phone: () Fax: () Email: In person Online Phone: () Fax: () Email: In person Online Phone: () Fax: () Email: In person Online Phone: () Fax: () Email: In person Online Phone: () Fax: () Email: In person Online Phone: () Fax: () Email: Other Contact name or position, or job reference number or confirmation notice Type of contact (Include position applied for or name of approved WorkSource activity if applicable) Application / resume Interview Inquiry
Street, P.O. box or web address
WorkSource activity
City, state
Other
CONTACT 8
Inquiry
WorkSource activity
Other
CONTACT 9
Inquiry
WorkSource activity
Other
CONTACT 10
Inquiry
WorkSource activity
Other
CONTACT 11
Inquiry
WorkSource activity
Other
CONTACT 12
Inquiry
WorkSource activity
Other
CONTACT 13
Inquiry
WorkSource activity
Other
CONTACT 14
Inquiry
WorkSource activity
Other
CONTACT 15
Inquiry
WorkSource activity

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Job Search Log

NAME: George S. Hernandez ID: 882035373 1

Keep this document for your records

Employer contacts and job search activities

Contact name or position, or job reference number or confirmation notice

Street, P.O. box or web address

Application / resume Interview

Application / resume Interview

Other Application / resume Interview Inquiry

In person Online Phone: () Fax: ()

Application / resume Interview

Application / resume Interview Inquiry

For official use only

Street, P.O. box or web address

Application / resume Interview

Application / resume Interview

Application / resume Interview

Application / resume Interview

Application / resume Interview

Application / resume Interview

Application / resume Interview

Application / resume Interview

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