Submit a request – Tennessee Department of Labor and Workforce Development

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Subject

Description

Employer Name

State Unemployment Account Number

Please enter your employer account number if this is regarding unemployment taxes

Your first name

Your last name

First and last name of contact person for employer

Please enter your first and last name or the full name of the employer representative for us to contact

Employer name and mailing address

Employer contact job title

Please enter your job title

Your phone number

Email address

County

Preferred Contact Method

Other relevant contact information

Federal Employer ID Number (FEIN)

SIDES PIN

Optional-Please enter your 4 digit SIDES PIN

Unemployment Employer Account Number (EAN)

Refusal of Work Type

Are you reporting 5 or more applicants who declined offers of suitable work?

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

Last four digits of social security number for the applicant (if available)

Phone number of applicant who refused work

Email address of applicant who refused 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".

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

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

Attachments

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