Form ADJ034F "Work Search Record" - Illinois

What Is Form ADJ034F?

This is a legal form that was released by the Illinois Department of Employment Security - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2011;
  • The latest edition provided by the Illinois Department of Employment Security;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form ADJ034F by clicking the link below or browse more documents and templates provided by the Illinois Department of Employment Security.

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Download Form ADJ034F "Work Search Record" - Illinois

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State of Illinois
Department of Employment Security
www.ides.illinois.gov
Work Search Record
Claimant Information:
Last Name:
First Name:
MI:
ID or SSN:
(Este es un documento importante. Si usted necesita un intérprete, póngase en contacto con su oficina local.)
Instructions: Please use this form to keep a record of the work search efforts you made. Be sure that all requested
information is provided. Failure to do so may result in a denial of benefits. If you need additional pages, contact your local
office or duplicate this form.
Important Notice: Keep Your Work Search Records
A determination that you were actively seeking work during a week being claimed is subject to reconsideration despite the fact
that you have been paid benefits or returned to work. In order to preserve evidence that you were actively seeking work, do
not discard your written work search record for any week being claimed until 53 weeks have passed from the end of that week.
Further, if there is an appeal pending regarding your active work search for a week, keep your written work search record until
there has been a final resolution of the matter.
Click here for the Work Search Explanation.
Week Ending
Contact
Name & Address of Contact
Person Contacted
Method of
Type of Work
Results
Date
Contact
Sought
Week Ending
Contact
Name & Address of Contact
Person Contacted
Method of
Type of Work
Results
Date
Contact
Sought
ADJ034F
Page 1 of 2
TCS-2
Rev. (09/2011)
Print
Save
State of Illinois
Department of Employment Security
www.ides.illinois.gov
Work Search Record
Claimant Information:
Last Name:
First Name:
MI:
ID or SSN:
(Este es un documento importante. Si usted necesita un intérprete, póngase en contacto con su oficina local.)
Instructions: Please use this form to keep a record of the work search efforts you made. Be sure that all requested
information is provided. Failure to do so may result in a denial of benefits. If you need additional pages, contact your local
office or duplicate this form.
Important Notice: Keep Your Work Search Records
A determination that you were actively seeking work during a week being claimed is subject to reconsideration despite the fact
that you have been paid benefits or returned to work. In order to preserve evidence that you were actively seeking work, do
not discard your written work search record for any week being claimed until 53 weeks have passed from the end of that week.
Further, if there is an appeal pending regarding your active work search for a week, keep your written work search record until
there has been a final resolution of the matter.
Click here for the Work Search Explanation.
Week Ending
Contact
Name & Address of Contact
Person Contacted
Method of
Type of Work
Results
Date
Contact
Sought
Week Ending
Contact
Name & Address of Contact
Person Contacted
Method of
Type of Work
Results
Date
Contact
Sought
ADJ034F
Page 1 of 2
TCS-2
Rev. (09/2011)
ID/SSN:
Name:
Week Ending
Contact
Name & Address of Contact
Person Contacted
Method of
Type of Work
Results
Date
Contact
Sought
Week Ending
Contact
Name & Address of Contact
Person Contacted
Method of
Type of Work
Results
Date
Contact
Sought
Week Ending
Contact
Name & Address of Contact
Person Contacted
Method of
Type of Work
Results
Date
Contact
Sought
Week Ending
Contact
Name & Address of Contact
Person Contacted
Method of
Type of Work
Results
Date
Contact
Sought
ADJ034F
Page 2 of 2
Print
Save
Page of 2