Submit a request

Refusal of Work Type

Are you reporting 5 or more employees that declined to return to work?

What is the employer business name?

What is the employer business address?

Enter the contact information for the business. (e.g. business phone number, email address for employer)

Has Personal Protective Equipment (PPE) been provided for employees?

Full name of employee that declined to return to work

Full name of applicant who declined work

Last four digits of social security number for employee that declined to return to work

Please provide the contact information for the employee that has declined to return to work. Enter both the phone number and email address if both are available.

Previous position/title of employee at time of business closing

Is recall for the same position/job that the employee held at time of business closing?

Was the employee full-time or part-time at the time of business closing?

How many hours a week did the employee work at the time of business closing/separation?

How many hours were offered at the time of recall?

What was the employee's hourly pay at time of business closing?

What was the employee's pay offered at recall?

How was the employee notified of recall? (e.g. in-person, voicemail, phone call, email, etc.)

Has employee responded to the recall?

Was there a deadline to respond? If Yes, when was the deadline? If there was no deadline, answer "No".

Please provide any details of the employee's response to the notification to recall, including the reason given for declining.

What date was the employee given to report back to work?

Was a job offered?

What type of work was offered?

What are the specific duties of the job offered?

What was the start date of the job offered?

What date was the job offer declined?

What was the rate of pay offered?

Was the applicant offered full-time or part-time work?

How many hours per week were offered to the applicant?

What was the expected duration of the job?

Was transportation provided as part of the job offer?

How was the job offer conveyed? (e.g. phone, letter, in-person, other)

Did the applicant's training or work experience indicate that he/she was qualified to perform this type of work?

Please list the reason given for refusal of the job