RESEA - Work Search Record Form

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 with two weeks of work search history may result in disqualification from receiving benefits or a potential overpayment for benefits already received.

BC-151.3 (R-06-24)

Participant Details

Today's Date:

One-Stop Office (As indicated on your RESEA selection notice) Value is not selected

Interview date

First Name

Last Name

Last 4 digits of Your Social Security #:

Email Address:

Your Phone Number

Work Search History

Work Search History: Week 1
This week must begin two weeks prior to the above referenced interview date. No more than three activities can be entered.

Week 1 Starting Sunday (date):

Week 1 Ending Saturday (date):

Contact Date

Position / Activity Type

Employer / Activity Name

Employer / Activity Address

Person Contacted

Type of Contact Value is not selected

If "Other" for "Type of Contact"

Result

Are you ready to enter work search history for week two? Reminder: two weeks of work search history is required. Value is not selected

Work Search History: Week 2
This week must begin one week prior to the above referenced interview date. No more than three activities can be entered.

Week 2 Starting Sunday (date):

Week 2 Ending Saturday (date):

Contact Date

Position / Activity Type

Employer / Activity Name

Employer / Activity Address

Person Contacted

Type of Contact Value is not selected

If "Other" for "Type of Contact"

Result

Week 1

Date - 1.1

Position/Activity: - 1.1

Employer/Activity name: - 1.1

Person contacted: - 1.1

Type of contact: - 1.1

Result: - 1.1

Explain Other type of contact - 1.1

Date: - 1.2

Position/Activity: - 1.2

Employer/Activity name: - 1.2

Person contacted: - 1.2

Type of contact: - 1.2

Result: - 1.2

Explain Other type of contact: - 1.2

Date: - 1.3

Position/Activity: - 1.3

Employer/Activity name: - 1.3

Person contacted: - 1.3

Type of contact: - 1.3

Result: - 1.3

Explain Other type of contact: - 1.3

Week 2

Date: - 2.1

Position/Activity:- 2.1

Employer/Activity name:- 2.1

Person contacted: - 2.1

Type of contact:- 2.1

Result:- 2.1

Explain Other type of contact- 2.1

Date- 2.2

Position/Activity- 2.2

Employer/Activity name:- 2.2

Person contacted- 2.2

Type of contact- 2.2

Result- 2.2

Explain Other type of contact- 2.2

Date:- 2.3

Position/Activity:- 2.3

Employer/Activity name:- 2.3

Person contacted:- 2.3

Type of contact:- 2.3

Result:- 2.3

Explain Other type of contact:- 2.3

OneStop Location Email: Group LO

County Team Member Email

County Team Member Name

WSR Participant Name

Container 1a

Container 1 Contact Date 1

Container 1 Position / Activity 1

Container 1 Employer / Activity Name 1

Container 1 Employer / Activity Address 1

Container 1 Person Contacted 1

Container 1 Type of Contact 1

Container 1 Other Contact Method 1

Container 1 Result 1

Container 1 Contact Type/Method Logic 1

Container 1b

Container 1 Contact Date 2

Container 1 Position / Activity 2

Container 1 Employer / Activity Name 2

Container 1 Employer / Activity Address 2

Container 1 Person Contacted 2

Container 1 Type of Contact 2

Container 1 Other Contact Method 2

Container 1 Result 2

Container 1 Contact Type/Method Logic 2

Container 1c

Container 1 Contact Date 3

Container 1 Position / Activity 3

Container 1 Employer / Activity Name 3

Container 1 Employer / Activity Address 3

Container 1 Person Contacted 3

Container 1 Type of Contact 3

Container 1 Other Contact Method 3

Container 1 Result 3

Container 1 Contact Type/Method Logic 3

Container 2a

Container 2 Contact Date 1

Container 2 Position / Activity 1

Container 2 Employer / Activity Name 1

Container 2 Employer / Activity Address 1

Container 2 Person Contacted 1

Container 2 Type of Contact 1

Container 2 Other Contact Method 1

Container 2 Result 1

Container 2 Contact Type/Method Logic 1

Container 2b

Container 2 Contact Date 2

Container 2 Position / Activity 2

Container 2 Employer / Activity Name 2

Container 2 Employer / Activity Address 2

Container 2 Person Contacted 2

Container 2 Type of Contact 2

Container 2 Other Contact Method 2

Container 2 Result 2

Container 2 Contact Type/Method Logic 2

Container 2c

Container 2 Contact Date 3

Container 2 Position / Activity 3

Container 2 Employer / Activity Name 3

Container 2 Employer / Activity Address 3

Container 2 Person Contacted 3

Container 2 Type of Contact 3

Container 2 Other Contact Method 3

Container 2 Result 3

Container 2 Contact Type/Method Logic 3

If you choose to SAVE your work, you will get an email with a link to finish and submit the form later.

If you indicate that your work has been COMPLETED, your submission will go to your NJDOL RESEA One-Stop Office.

Only click the BACK button if you need to change anything.

Is your work complete and ready to submit? Value is not selected

WARNING: You must select 'No' above since you did not enter work search history for week two.

NOTE Please check the most recent email and click on the new link to edit the WSR form The email subject is 'Your NJDOL RESEA Work Search Record form has been saved.'

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