UI ELIGIBILITY REVIEW Questionnaire for Unemployment Compensation Name Last Four of Social Security Number Date Complete the survey below and make notes, as necessary, in the Comments section. You must meet the following requirements to continue receiving Unemployment Compensation benefits. Results Comments 1. Yes No Do the skills, work history and educational credentials listed in meet your occupational Connecting Colorado’s registration goal(s)? 2. Yes No Are you to a former employer or a union hall? If job attached yes, please provide the employer name or union hiring hall. If yes, are you able and available to be called into work at any time by the employer or union hall? Yes No 3. Yes No Are you currently in an (approved approved training program by Unemployment or Workforce Center)? If yes, are you able and available to attend your scheduled Yes No training? Are you in training that has not been reported to Unemployment Yes No or the Workforce Center? 4. Yes No Are you physically and mentally able to do the work you are seeking? For example, are you able to perform the duties that are required for the jobs in which you are seeking? Do you have the capacity to complete the required functions of the job? Do you possess the basic qualifications and requirements of the job(s)? 5. Are you to seek and accept work? Yes No available For example, do you have any limitations that would prevent you from applying for jobs, attending an interview, or accepting a job offer? 6. Yes No Have you been actively seeking work? Yes No Have you made your required weekly job contacts? Note: Every contact must be for a job that you can and will accept, if offered. If your claim is based on full-time work, you must seek full-time work. 7. Yes No Have you separated from a job recently, not already reported to Unemployment? If yes, please provide the name of the employer you separated from, along with your last day worked. 8. Yes No Have you turned down a job offer recently, not already reported to Unemployment? If yes, please provide the name of the job you refused. employer’s 9. Yes No Did you provide your work-search log for the one-on-one appointment? Yes No Does the log meet the acceptable UI standards and requirements?
UI ELIGIBILITY REVIEW Questionnaire for Unemployment Compensation Name Last Four of Social Security Number Date Complete the survey below and make notes, as necessary, in the Comments section. You must meet the following requirements to continue receiving Unemployment Compensation benefits. Results Comments 1. Do the skills, work history and educational credentials listed in Connecting Colorado’s registration meet your occupational goal(s)? Yes No 2. Are you job attached to a former employer or a union hall? If yes, please provide the employer name or union hiring hall. If yes, are you able and available to be called into work at any time by the employer or union hall? Yes No Yes No 3. Are you currently in an approved training program (approved by Unemployment or Workforce Center)? If yes, are you able and available to attend your scheduled training? Are you in training that has not been reported to Unemployment or the Workforce Center? Yes No Yes No Yes No 4. Are you physically and mentally able to do the work you are seeking? For example, are you able to perform the duties that are required for the jobs in which you are seeking? Do you have the capacity to complete the required functions of the job? Do you possess the basic qualifications and requirements of the job(s)? Yes No 5. Are you available to seek and accept work? For example, do you have any limitations that would prevent you from applying for jobs, attending an interview, or accepting a job offer? Yes No 6. Have you been actively seeking work? Have you made your required weekly job contacts? Note: Every contact must be for a job that you can and will accept, if offered. If your claim is based on full-time work, you must seek full-time work. Yes No Yes No 7. Have you separated from a job recently, not already reported to Unemployment? If yes, please provide the name of the employer you separated from, along with your last day worked. Yes No 8. Have you turned down a job offer recently, not already reported to Unemployment? If yes, please provide the employer’s name of the job you refused. Yes No 9. Did you provide your work-search log for the one-on-one appointment? Does the log meet the acceptable UI standards and requirements? Yes No Yes No
PGL-WP-2016-02-RESEA-Guidance-attach-04-UI%20Eligibility%20Review%20Questionnaire.docx