New Jersey Department of Labor and Workforce Development

Re-Employment Services and Eligibility Assessment (RESEA) Program

Work Search Record (WSR) Form

To continue receiving unemployment benefits, you must list all the employers and labor unions you contact each week while claiming Unemployment Insurance benefits. This form will help you keep record of your work search contacts. The Division of Unemployment Insurance may ask you to provide proof of your search for work at any time while you are claiming benefits. You must contact at least one different employer each week. You may also include information related to work search activities such as emails with employers, job application receipts, job postings, job fair announcements, networking club information, resume assistance or One-Stop Career Center Services.

Please note that failure to submit a complete form when requested may result in disqualification from receiving benefits or a potential overpayment for benefits already received.

* Required

BC-151.3 (R-06-23)

Today's Date: WSR initial entry date

Please choose the One-Stop location indicated in your RESEA Selection Notice:

Interview date (shown on your RESEA Selection Notice): Current or future date

Your Name: First MI Last (Full Name)

Last 4 digits of Your Social Security #: Must be numeric

Email Address: Personal email

Your Phone #: Preferred contact #

WEEK 1 (must be two weeks prior to the above Interview date (shown on your RESEA Selection Notice))

Week 1 Starting Sunday (date):

Week 1 Ending Saturday (date):

Date any day in wk#1

Position / Activity

Employer / Activity name and address

Person contacted

Type of contact

Result

Date: any day in wk#1

Position/Activity:

Employer/Activity name and address:

Person contacted:

Type of contact: Value is not selected

Result:

Explain Other type of contact

Date: any day in wk#1

Position/Activity:

Employer/Activity name and address:

Person contacted:

Type of contact: Value is not selected

Result:

Explain Other type of contact:

Date: any day in wk#1

Position/Activity:

Employer/Activity name and address:

Person contacted:

Type of contact: Value is not selected

Result:

Explain Other type of contact:

WEEK 2 (must be one week prior to the above Interview date (shown on your RESEA Selection Notice))

Week 2 Starting Sunday (date):

Week 2 Ending Saturday (date):

Date any day in wk#2

Position / Activity

Employer / Activity name and address

Person contacted

Type of contact

Result

Date: any day in wk#2

Position/Activity:

Employer/Activity name and address:

Person contacted:

Type of contact: Value is not selected

Result:

Explain Other type of contact

Date any day in wk#2

Position/Activity

Employer/Activity name and address

Person contacted

Type of contact Value is not selected

Result

Explain Other type of contact

Date: any day in wk#2

Position/Activity:

Employer/Activity name and address:

Person contacted:

Type of contact: Value is not selected

Result:

Explain Other type of contact:

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RESEA - Work Search Record Form