Reporting of Interview No Show or Refusal of Work Offered - Page 1 of 2

Reporting of Interview No Show or Refusal of Work Offered

Reporting of Interview No Show or Refusal of Work Offered

Job Service of North Dakota
Unemployment Insurance/Applicant Services
SFN 61977

1Reporting Information > 2Comments
Employer Name *
Maximum of 100 characters allowed. Currently Entered: 0 characters.
- Address *
  Maximum of 30 characters allowed. Currently Entered: 0 characters.
- City *
  Maximum of 25 characters allowed. Currently Entered: 0 characters.
- State *
- ZIP Code *
  Must be 5 characters. Currently Entered: 0 characters.
- Name of Person Reporting
  First *
  Maximum of 12 characters allowed. Currently Entered: 0 characters.
- MI
  Maximum of 1 characters allowed. Currently Entered: 0 characters.
- Last *
  Maximum of 30 characters allowed. Currently Entered: 0 characters.
- Telephone Number * - ### - ### ####
- Applicant Name
  First *
  Maximum of 12 characters allowed. Currently Entered: 0 characters.
- MI
  Maximum of 1 characters allowed. Currently Entered: 0 characters.
- Last *
  Maximum of 30 characters allowed. Currently Entered: 0 characters.
- Telephone Number * - ### - ### ####
Applicant Email Address
Applicant Status *
No Show for Interview Refused Offer of Work Unable to Contact for Interview, Offer Work, or Recall to Work
No Show for Interview Information
- Date of Interview *
- Date Applicant Notified of the Interview *
How was the Applicant notified? *
Did the Applicant confirm their attendance for the interview? *
Yes No
Did the Applicant contact you prior to the interview date to reschedule? *
Yes No
Refused Offer of Work Information
- Date Offer of Work was Made *
- Position Offered *
  Maximum of 100 characters allowed. Currently Entered: 0 characters.
Summary of Position Dutiies *
Maximum of 2000 characters allowed. Currently Entered: 0 characters.
- Starting Date of the Work *
- Hourly Rate of Pay Offered * $ . Dollars Cents
Reason the individual provided for refusing the work offered: *
Maximum of 2000 characters allowed. Currently Entered: 0 characters.
Unable to Contact Information
Unable to Contact Reason *
Unable to Contact for Interview Unable to Contact to Offer Work Unable to Contact for Work Recall
Date Contact Attempted *
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Date of Second Contact Attempt
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Date of Third Contact Attempt
Total Number of Attempts You Made to Contact the Individual *
Methods Used to Contact the Claimant *
Telephone Text Email In Person Other
Contact Information
- Telephone Number - ### - ### ####
- Email Address
Check here to add another contact information
Contact Information #2
- Telephone Number - ### - ### ####
- Email Address
Check here to add another contact information
Contact Information #3
- Telephone Number - ### - ### ####
- Email Address