BAP Work Search Declaration

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Address

Street Address
Street Address 2
City	State
Postal Code	Country

Phone

Area CodePhone Number

Is the person filling out this form the same person listed above?

Yes
No

Age of person completing form

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.

How many employers did you contact each week?

If possible, provide a copy of documents showing your work search activities (job search logs, job postings, e-mails, etc). Documents can be provided by mail, fax, or through OAH’s participant portal.

If you were not looking for full time work, how many hours per week are you available to work?

What type of work do you normally do?

If no, explain why not:

Name of Union:

Were you available for dispatch during the weeks claimed?

Yes
No

Name of employer:

Were your hours temporarily reduced during this period?

Yes
No. My employer did not have any work for me during this period.

My schedule was reduced to (number of hours) per week

Did you accept an offer of work, during the week(s) indicated in the Determination Letter?

Yes
No

What date was the offer of employment made?

What date did you start work with the new employer?

Are you employed, but temporarily stopped working?

Yes
No

When did you stop working?

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.

3. Did you engage in at least three work search activities (including employer contacts) each week?

Yes
No

Describe your limitations (Examples include: School attendance, vacation, injury or illness, lack of transportation, or lack of childcare):

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.