BAP Availability

Address

Street Address
Street Address 2
City	State
Postal Code / ZipCode	Country

Phone

Area CodePhone Number

Please answer all of the following questions. Some of the questions may have been asked during the Employment Security Department’s investigation. Please answer the questions here, even if you answered the same questions before.

The following questions are about the period you were unemployed or partially unemployed (in other words, the period you are requesting benefits for).

Name of person filling out this form

Relation to Claimant

Please give details about (i) your sickness and/or injuries, and (ii) when or if you have recovered enough to perform full time work.

Please give details about (i) your transportation problems, and (ii) when or if those transportation problems got resolved.

Who were you caring for?

Are you still caring for them?

What type of academic program were you enrolled in?

What is your customary profession?

If you were offered full time work which conflicted with your academic schedule, could you change your class schedule?

Yes

No

6. Did you perform at least the minimum required work searches for each of the weeks you have been requesting benefits, starting the week of July 4, 2021?

Yes

No

What weeks did you not perform the minimum required work searches?

6a. Were you a member of a Union?

Yes

No

Were you a member in good standing?

Yes

No

6b. Were you employed?

Yes

No

Dates of employment:

If yes, I usually work (number of hours) per week

Did you return to work? Were your hours increased to your usual schedule? Please explain

Name of employer:

What date did the new employer offer for you to start work?

Provide a copy of your written offer of work, if there was one. Documents can be provided by mail, fax, or through OAH’s participant portal.

Why did you stop working?

When did you or do you expect to resume work for your employer?

If yes, provide a copy of your Commissioner Approved Training (CAT) Determination Letter. Documents can be provided by mail, fax, or through OAH’s participant portal.

Please describe what those reasons are in detail.

I declare under penalty of perjury under the laws of the state of Washington that the facts I have provided on this form are true.

I agree.

Washington State
Office of Administrative Hearings

Able and Available Declaration