Job-Search Log for the week ending (Mo/Day/Yr) / /
Name:	ID or SSN:	Keep this log for your records*
Instructions: Please use dark ink only. Do not send your logs to us unless we ask for them. You must complete a 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. Keep your logs. * We may review them 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 contacted them for work. Providing false information is fraud that can result in a denial of your unemployment benefits and additional penalties.

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 if available. Refer to your Handbook for Unemployed Workers for further instructions on completing this log.
Contacts and job-search activities	Keep this log for your records
CONTACT 1

Staff use only	( SKIES ____

Contact date

(Mo/Day/Yr)

Employer contact

OR

WorkSource activity	FOR EMPLOYER CONTACT, check one AND list position or type of work applied for:

Application/résumé	Interview	Inquiry

Position:

How contacted:

Online/email	Fax	In person

Mail	Kiosk	Telephone

Other (describe):

FOR WORKSOURCE ACTIVITY, briefly describe:

If employer contact was in person, by kiosk or by telephone, you MUST complete this section.

Employer	Telephone ( )
Address	City	State
Name or position of person contacted
If employer contact was made online, by email, by fax or by newspaper, you MUST complete the appropriate information in this section.

Employer name (if provided)	Website or email
Job reference number
If fax, provide the fax number ( )
Newspaper name	Publication date
CONTACT 2

Staff use only	( SKIES ____

Contact date

(Mo/Day/Yr)

Employer contact

OR

WorkSource activity	FOR EMPLOYER CONTACT, check one AND list position or type of work applied for:

Application/ résumé	Interview	Inquiry

Position:

How contacted:

Online/email	Fax	In person

Mail	Kiosk	Telephone

Other (describe):

FOR WORKSOURCE ACTIVITY, briefly describe:

If employer contact was in person, by kiosk or by telephone, you MUST complete this section.

Employer	Telephone ( )
Address	City	State
Name or position of person contacted
If employer contact was made online, by email, by fax or by newspaper, you MUST complete the appropriate information in this section.

Employer name (if provided)	Website or email
Job reference number
If fax, provide the fax number ( )
Newspaper name	Publication date
CONTACT 3

Staff use only	( SKIES ____

Contact date

(Mo/Day/Yr)

Employer contact

OR

WorkSource activity	FOR EMPLOYER CONTACT, check one AND list position or type of work applied for:

Application/ résumé	Interview	Inquiry

Position:

How contacted:

Online/email	Fax	In person

Mail	Kiosk	Telephone

Other (describe):

FOR WORKSOURCE ACTIVITY, briefly describe:

If employer contact was in person, by kiosk or by telephone, you MUST complete this section.

Employer	Telephone ( )
Address	City	State
Name or position of person contacted
If employer contact was made online, by email, by fax or by newspaper, you MUST complete the appropriate information in this section.

Employer name (if provided)	Website or email
Job reference number
If fax, provide the fax number ( )
Newspaper name	Publication date
For official

use only	Week being verified	Entitlement	Reschedule	WS office name or #	Claims Center #	Staff initials

EMS 10313 CC 7540-032-823 Rev 3/13

Job-Search Log for the week ending (Mo/Day/Yr)	/ / Keep this log for your records*
Name:	ID or SSN:
Instructions: Please use dark ink only. Do not send your logs to us unless we ask for them. You must complete a 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. Keep your logs. * We may review them 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 contacted them for work. Providing false information is fraud that can result in a denial of your unemployment benefits and additional penalties.

Contacts and job-search activities	Keep this log for your records
CONTACT 4

Staff use only	( SKIES ____

Contact date

(Mo/Day/Yr)

Employer contact

OR

WorkSource activity	FOR EMPLOYER CONTACT, check one AND list position or type of work applied for:

Application/ résumé	Interview	Inquiry

Position:

How contacted:

Online/email	Fax	In person

Mail	Kiosk	Telephone

Other (describe):

FOR WORKSOURCE ACTIVITY, briefly describe:

If employer contact was in person, by kiosk or by telephone, you MUST complete this section.

Employer	Telephone ( )
Address	City	State
Name or position of person contacted
If employer contact was made online, by email, by fax or by newspaper, you MUST complete the appropriate information in this section.

Employer name (if provided)	Website or email
Job reference number
If fax, provide the fax number ( )
Newspaper name	Publication date
CONTACT 5

Staff use only	( SKIES ____

Contact date

(Mo/Day/Yr)

Employer contact

OR

WorkSource activity

FOR EMPLOYER CONTACT, check one AND list position or type of work applied for:

Application/ résumé	Interview	Inquiry

Position:

How contacted:

Online/email	Fax	In person

Mail	Kiosk	Telephone

Other (describe):

FOR WORKSOURCE ACTIVITY, briefly describe:

If employer contact was in person, by kiosk or by telephone, you MUST complete this section.

Employer	Telephone ( )
Address	City	State
Name or position of person contacted
If employer contact was made online, by email, by fax or by newspaper, you MUST complete the appropriate information in this section.

Employer name (if provided)	Website or email
Job reference number
If fax, provide the fax number ( )
Newspaper name	Publication date
CONTACT 6

Staff use only	( SKIES ____

Contact date

(Mo/Day/Yr)

Employer contact

OR

WorkSource activity

FOR EMPLOYER CONTACT, check one AND list position or type of work applied for:

Application/ résumé	Interview	Inquiry

Position:

How contacted:

Online/email	Fax	In person

Mail	Kiosk	Telephone

Other (describe):

FOR WORKSOURCE ACTIVITY, briefly describe:

If employer contact was in person, by kiosk or by telephone, you MUST complete this section.

Employer	Telephone ( )
Address	City	State
Name or position of person contacted
If employer contact was made online, by email, by fax or by newspaper, you MUST complete the appropriate information in this section.

Employer name (if provided)	Website or email
Job reference number
If fax, provide the fax number ( )
Newspaper name	Publication date
For official

use only	Week being verified	Entitlement	Reschedule	WS office name or #	Claims Center #	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 interpretive services free of charge to the customer in order to conduct business with the department.

INSTRUCTIONS: You must complete a Job Search Log for each week you claim unemployment insurance

Mary K MacLennan

2011-09-30

eklasinski

Employment Security Dept.