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 Position Business/Employer Name and title Method Contact information for Result of contact
of applied name of person of contact method of contact listed (if known)
contact for contacted (In person, phone, fax, (address, telephone number, (Interview, waiting for
(if known) email, web site, etc.) email, website/URL, fax response, not hired)
number)
John Smith,
1/2/2014 Clerk ABC Industries HR Director email [email protected] 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 1 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 fraud 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 (7) Use the telephone, business directories, internet, social media, or
through a virtual career center platform provided by the online job matching systems to search for jobs, get leads, request
Department of Labor. Examples include: referrals, or make appointments for job interviews.
(i) meet with Career Center advisors; (8) Any other reasonable activity that may help you become
employed.
(ii) receive job market information from Career Center staff about
jobs in your industry or region;
(iii) complete skills assessments for job matching; Keep copies of your Work Search Records for one year. Do not
send your Work Search Record to the Department of Labor unless
(iv) attend instructional workshops; and
we ask you to. You can get more forms at your local New York
(v) get job referrals from the Career Center and follow up with State Career Center, online at www.labor.ny.gov or in your
employers. claimant handbook. You may also keep your work search record
(2) Submit job applications or resumes to employers or former online at www.jobzone.ny.gov.
employers who may have openings.
*If you have a Work Search Plan approved by the Department of
(3) Attend job search seminars, career networking meetings, job fairs,
or employment-related workshops that offer job-search skills Labor, you must do what was agreed upon in the plan and record
instruction. those activities on the Work Search Record. We will check your
Work Search Record to be sure you are doing what is called for
(4) Interview with employers.
in your Work Search Plan.
(5) Register for, apply for, 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.

WS 5 (01/22) Equal Opportunity Program - Auxiliary aids and services are available upon request to individuals with disabilities Page 2 of 2