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Maryland Division of Unemployment Insurance 1100 N. Eutaw St., Baltimore, MD 21201 You must make three (3) job contacts for each week that you file a continued claim (request for payment) by Webcert or Telecert. (El formulario en espanol es solamente para demostracion, tiene que completar y regresar el formulario en INGLES). You should retain this record in case your work search is audited. Making false statements may lead to a finding of unemployment insurance fraud. Date Mo/Day/Yr Employer Name, Address, Phone Number, E-mail Address or Website How Contacted Person Contacted and Title Type of Work Sought Results Application or Resume submitted? E-mail or Website Confirmation Number Always submit applications, unless the employer specifically says they aren't accepting any at that time. Work-Search Notes: 1. Keep copies of email or website confirmations in either paper or electronic form. 2. Attempt to contact people with hiring authority when seeking work. 3. 4. Reading newspaper, bulletin board, or website job listings do not constitute a valid "job contact". You must apply for a specific job. Website E-mail Mail Phone/Fax In Person Hired Pending Not Hiring No Yes Phone/Fax Mail E-mail Website In Person Phone/Fax Mail E-mail Website In Person Pending Hired Not Hiring No Yes Pending Hired Not Hiring No Yes Website E-mail Mail Phone/Fax In Person Hired Pending Not Hiring No Yes Phone/Fax Mail E-mail Website In Person Website E-mail Mail Phone/Fax In Person Not Hiring Hired Pending Yes No Hired Pending Not Hiring No Yes Save Form Print Form Reset Form

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Maryland Division of Unemployment Insurance 1100 N. Eutaw St., Baltimore, MD 21201

You must make three (3) job contacts for each week that you file a continued claim (request for payment) by Webcert or Telecert. (El formulario en espanol es solamente para demostracion, tiene que completar y regresar el formulario en INGLES). You should retain this record in case your work search is audited. Making false statements may lead to a finding of unemployment insurance fraud.

Date Mo/Day/Yr

Employer Name, Address, Phone Number, E-mail Address or Website

How Contacted Person Contacted and Title

Type of Work Sought

Results Application or Resume submitted?

E-mail or Website

Confirmation Number

Always submit applications, unless the employer specifically says they aren't accepting any at that time.

Work-Search Notes:

1. Keep copies of email or website confirmations in either paper or electronic form.2. Attempt to contact people with hiring authority when seeking work.

3. 4. Reading newspaper, bulletin board, or website job listings do not constitute a valid "job contact". You must apply for a specific job.

WebsiteE-mailMailPhone/FaxIn Person

HiredPendingNot Hiring

NoYes

Phone/FaxMailE-mailWebsite

In Person

Phone/FaxMailE-mailWebsite

In Person

PendingHired

Not Hiring

NoYes

PendingHired