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Get GA DOL-2798 2013

GEORGIA DEPARTMENT OF LABOR GDOL WEEKLY WORK SEARCH RECORD Name please print Social Security Number You must make at least three new job contacts each week. A signature is required to be considered a completed record. Claimant s Signature DOL-2798 R-01/13. You are required to keep a detailed record of your work search activities and submit evidence of three verifiable contacts as a part of your weekly certification* A claim week begins on Sunday and ends on Saturday at midnight. Your work search efforts are subject to audit by GDOL* Failure to submit a completed weekly work search record for any week claimed or listing any unverifiable contacts may result in a denial and/or repayment of benefits. Weekly work search records must be submitted by one of the following methods Internet or fax. The faster more preferred method is to submit by Internet. If you choose to fax your records you must submit this form completed with your signature to one of the following numbers 404-525-3605 404-525-3606 or 1-877-302-1573 toll-free. Other work search forms will not be accepted* We recommend you submit your work search immediately upon completing your weekly certification by Internet or Interactive Voice Response IVR. For each week claimed record your work search activity on this form completing all of the required information* The contact information provided must correspond with the week claimed* Retain a copy of this form for your records. Please fill in the information below Report for the week of Sunday Contact Date Employer Name through Saturday Employer Contact Information address phone e-mail Person Contacted if applicable Method of Contact Type of Work Sought Results/Outcome CERTIFICATION STATEMENT I certify all information I have provided on this form is true and correct. I understand the law provides severe penalties for any person making false statements or representation as to a material fact knowing the same to be false in order to receive benefits. You are required to keep a detailed record of your work search activities and submit evidence of three verifiable contacts as a part of your weekly certification* A claim week begins on Sunday and ends on Saturday at midnight. Your work search efforts are subject to audit by GDOL* Failure to submit a completed weekly work search record for any week claimed or listing any unverifiable contacts may result in a denial and/or repayment of benefits. Your work search efforts are subject to audit by GDOL* Failure to submit a completed weekly work search record for any week claimed or listing any unverifiable contacts may result in a denial and/or repayment of benefits. Weekly work search records must be submitted by one of the following methods Internet or fax. The faster more preferred method is to submit by Internet. Weekly work search records must be submitted by one of the following methods Internet or fax. The faster more preferred method is to submit by Internet. If you choose to fax your records you must submit this form completed with your signature to one of the following numbers 404-525-3605 404-525-3606 or 1-877-302-1573 toll-free. .

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