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APPENDIX C – SAMPLE WORK SEARCH LOG Use a log such as the one shown below, which you can find at www.uc.pa.gov/Documents/UC_Forms/uc-304.pdf, to keep track of the work search activities you complete each week. Be sure to document the details of each action (what, when, where, and with whom). If possible, save a screenshot, email confirmation, or other evidence of your work search action. DEPARTMENT OF LABOR & INDUSTRY OFFICE OF UNEMPLOYMENT COMPENSATION BENEFITS WORK SEARCH RECORD WORK SEARCH RECORD FOR WEEK BEGINNING SUNDAY THROUGH SATURDAY To be eligible for UC benefits, complete the work search record below. Refer to your Pennsylvania UC Handbook (Form UCP-1) or go to www.uc.pa.gov for complete instructions or to print additional copies of this form. If you are working part-time, and earning more than your Partial Benefit Credit, initial here . JOB APPLICATIONS/INTERVIEWS WORK SEARCH ACTIVITY #1 Date of Application or Date of Interview Employer Employer Contact Name Employer Phone/Email How did you apply for the job Results Date of Activity Type of Activity Location of Activity Contact Name Contact Phone/Email #2 Date of Application or Date of Interview Employer Employer Contact Name Employer Phone/Email How did you apply for the job Results Date of Activity Type of Activity Location of Activity Contact Name Contact Phone/Email #3 Date of Application or Date of Interview Employer Employer Contact Name Employer Phone/Email How did you apply for the job Results Date of Activity Type of Activity Location of Activity Contact Name Contact Phone/Email EXEMPTION Name of Employer, Union Hiring Hall or Training Program Contact Name and Phone Number Written Date of Recall (attach copy) Union Hiring Hall Reemployment Services & Eligibility Assessment (RESEA) participants Shared Work program participants Trade Reduction Act participants I certify that all information I have provided in this document is correct and complete. I acknowledge that false statements in this document are punishable pursuant to 18 Pa.C.S. §4904, relating to unsworn falsification to authorities. Social Security Number XXX-XX- __ __ __ __ (last 4 digits) First Name M.I. Last Name Signature Date A person who knowingly makes a false statement or knowingly withholds information to obtain UC benefits commits a criminal offense under Section 801 of the UC Law, 43 P.S. §871, and may be subject to a fine, imprisonment, restitution and loss of future benefits. RESET PRINT SAVE AS UC-304 REV 09-22 (Page 1) Tip for documenting work search activities: Store your documentation in a single location, such as one folder in your house or on your computer. Pennsylvania Unemployment Compensation Handbook 22