Brief Adjudicative Proceeding Able and Available Declaration

Claimant Name
Address

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).  

1. Is the person filling out this form the same person listed above?
1. Person filling out not same as above fieldset
2. Did you suffer from any sicknesses or injuries that kept you from working full time?
3. Did you have adequate transportation to look for and get to work?
4. Do you care for anyone else (minor child, sick spouse, elder parent) that would keep you from performing full time work?
4. Care for someone else which keeps from performing full time work fieldset
5. Were you a full time student during this period?
5. Full time student fieldset
If you were offered full time work which conflicted with your academic schedule, could you change your class schedule?
Would you be willing to drop your classes to accept full time work if the offered work conflicted with your academic schedule?
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?
If requested, could you provide a list of those job searches?

For any week where you did not perform the minimum required work searches:

6a. Were you a member of a Union?
6a. Member of Union
Were you a member in good standing?
Were you available for dispatch during the weeks claimed?
6b. Were you employed?
6b. Employed Fieldset
Were your hours temporarily reduced during this period?
6c. Did you accept an offer of work?
6c. Accept offer of work fieldset
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.
6d. Were you employed, but temporarily stopped working?
6d. Were you employed fieldset
6e. Were you participating in full time training, with written approval of the Employment Security Department?

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.

7. Were there any other reasons you were not able or available for full time work?
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.