Job-search log for week ending (Month/Day/Year) ________________________

MM/DD/YYYY
Name (Last, First, Middle): _______________________________________________________________________ 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 WorkSource activities each week. Keep your job-search log for at least 30 days after you receive your last benefit payment.
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. Refer to your Handbook for Unemployed Workers for further instructions on completing this log.

Employer contacts and job-search activities Keep this log for your records.

CONTACT
1 Contact Date (MM/DD/YYYY): ____________ CONTACT
2 Contact Date (MM/DD/YYYY): ____________
CONTACT

3 Contact Date (MM/DD/YYYY): ____________

Was this an approved employer contact or WorkSource activity? Was this an approved employer contact or WorkSource activity? Was this an approved employer contact or WorkSource activity?

Choose one: o Employer contact o WorkSource activity Choose one: o Employer contact o WorkSource activity Choose one: o Employer contact o WorkSource activity

If this was an employer contact, please provide the following: If this was an employer contact, please provide the following: If this was an employer contact, please provide the following:

Job title or job reference number: Job title or job reference number: Job title or job reference number:
__________________________________________________ __________________________________________________ __________________________________________________
Employer or business name: Employer or business name: Employer or business name:
__________________________________________________ __________________________________________________ __________________________________________________
How did you make the contact? How did you make the contact? How did you make the contact?
o In-person o Online o By phone o By Email o By mail o In-person o Online o By phone o By Email o By mail o In-person o Online o By phone o By Email o By mail
o Other:__________________________________________ o Other:__________________________________________ o Other:__________________________________________
Type of contact (Choose one) Type of contact (Choose one) Type of contact (Choose one)
o Application/resume o Interview o Inquiry o Application/resume o Interview o Inquiry o Application/resume o Interview o Inquiry

Employer or business contact information: Employer or business contact information: Employer or business contact information:
Address: ____________________________________________ Address: ____________________________________________ Address: ____________________________________________
City: ___________________________________ State: ______ City: ___________________________________ State: ______ City: ___________________________________ State: ______
Website or email address: _____________________________ Website or email address: _____________________________ Website or email address: _____________________________
Phone number: ______________________________________ Phone number: ______________________________________ Phone number: ______________________________________

If this was an approved WorkSource activity, please If this was an approved WorkSource activity, please If this was an approved WorkSource activity, please
provide the following information: provide the following information: provide the following information:
What activity did you complete: What activity did you complete: What activity did you complete:
____________________________________________________ ____________________________________________________ ____________________________________________________
Where did you complete this activity? Where did you complete this activity? Where did you complete this activity?
Office name: ________________________________________ Office name: ________________________________________ Office name: ________________________________________
City: _________________________________ State:________ City: _________________________________ State:________ City: _________________________________ State:________

The Employment Security Department is an equal opportunity employer/program. Auxiliary aids and services are available upon request to individuals EMS 10313 CC 7540-032-823 Rev 022120
with disabilities. Language assistance services for limited English proficient individuals are available free of charge. Washington Relay Service: 711