Form UCB-12 "Work Search Action Log" - Wisconsin

What Is Form UCB-12?

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

Form Details:

  • Released on February 20, 2019;
  • The latest edition provided by the Wisconsin Department of Workforce Development;
  • 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 printable version of Form UCB-12 by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Workforce Development.

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Download Form UCB-12 "Work Search Action Log" - Wisconsin

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Department of Workforce Development
Work Search Action Log
Unemployment Insurance Division
ONLY SEND COPY IF REQUESTED
To continue receiving benefits you must:
▪ Perform at least 4 work search actions each week
SSN:
▪ Keep a record of your work search actions
▪ Keep acceptable proof of work search actions for 52 weeks
Name:
The department may request acceptable proof of your work
For Week Ending:
search actions at any time.
(use Saturday date)
Falsely reporting any information on your work search record may be an act of concealment
(see Part 7: Fraud and Quality
Control).
List work search actions performed below. All columns should be filled in with enough detail to allow verification of the work search action by the department.
Method of
Name and title of
Contact information
Result of contact
Date of
Work Search Action
Business/Employer
contact
person contacted
(e.g., address, phone number,
(e.g., interview, waiting for
Action
Performed
name
(e.g., in person, phone,
email, website/URL, fax number)
response, not hired)
(if known)
fax, email, website)
02/21/2019
Applied for Clerk position
ABC Industries
John Smith, HR Director
Email
j.smith@abcinc.com
Set up interview
Attended résumé
02/22/2019
Job Center of WI
Jane Doe, Coordinator
In person
200 Job Center Lane, City, WI
Completed workshop
preparation workshop
Your local Job Center receives job opening information from employers that is updated daily. You are encouraged to make frequent visits to the Job Center where
you can view, select and apply for job openings for which you are qualified and take advantage of the services that can help you in your job search. For the
address of the Job Center closest to your home, go to
https://JobCenterofWisconsin.com/directory
or call 1-888-258-9966.
UCB-12 (R. 02/20/2019)
Department of Workforce Development
Work Search Action Log
Unemployment Insurance Division
ONLY SEND COPY IF REQUESTED
To continue receiving benefits you must:
▪ Perform at least 4 work search actions each week
SSN:
▪ Keep a record of your work search actions
▪ Keep acceptable proof of work search actions for 52 weeks
Name:
The department may request acceptable proof of your work
For Week Ending:
search actions at any time.
(use Saturday date)
Falsely reporting any information on your work search record may be an act of concealment
(see Part 7: Fraud and Quality
Control).
List work search actions performed below. All columns should be filled in with enough detail to allow verification of the work search action by the department.
Method of
Name and title of
Contact information
Result of contact
Date of
Work Search Action
Business/Employer
contact
person contacted
(e.g., address, phone number,
(e.g., interview, waiting for
Action
Performed
name
(e.g., in person, phone,
email, website/URL, fax number)
response, not hired)
(if known)
fax, email, website)
02/21/2019
Applied for Clerk position
ABC Industries
John Smith, HR Director
Email
j.smith@abcinc.com
Set up interview
Attended résumé
02/22/2019
Job Center of WI
Jane Doe, Coordinator
In person
200 Job Center Lane, City, WI
Completed workshop
preparation workshop
Your local Job Center receives job opening information from employers that is updated daily. You are encouraged to make frequent visits to the Job Center where
you can view, select and apply for job openings for which you are qualified and take advantage of the services that can help you in your job search. For the
address of the Job Center closest to your home, go to
https://JobCenterofWisconsin.com/directory
or call 1-888-258-9966.
UCB-12 (R. 02/20/2019)