RESEA - UI Eligibility Form

New Jersey Department of Labor and Workforce Development

Re-Employment Services and Eligibility Assessment (RESEA) Program

 Unemployment Insurance Eligibility (UIE) Form

 

 

Please complete this form to verify your eligibility to receive unemployment benefits and to comply with the RESEA program requirements before you report to your scheduled workshop.  Answer all questions, then sign the worksheet. 

 

Failing to complete this form may affect your eligibility to receive unemployment benefits.

* Required

 

BC-151.2 (R-06-23)

 

 

Please choose the One-Stop location indicated in your RESEA Selection Notice:
1. Since filing your unemployment claim, have you been:
1a. Able and available to work?
1b. Actively seeking work?
2. Have you refused any work?:
3. Are you attending school or job training?
4a. Have you applied for or received any of the following? see below
4b. Have you reported this information to the Unemployment Insurance Division??
  • Continuation pay
  • Payments in lieu of notice
  • Retirement pay received from an employer on your claim
5. Have you returned to work?
Please indicate the type of employer:
Please indicate the type of work:
6. Do you have a future return to work date?
Please indicate the type of employer:
Please indicate the type of work:

PARTICIPANT SIGNATURE (official)

CERTIFICATION STATEMENT: I have answered these questions to obtain Unemployment Insurance benefits. I know the law provides penalties for making false statements. I understand that this information will be verified.

Before submitting the form, click the "Back" button to review your responses and correct any errors.

You are responsible for submitting accurate information.