Page 684

Date COMMONWEALTH OF VIRGINIA

VIEW SNAP E&T

DEPARTMENT OF SOCIAL SERVICES

EMPLOYMENT SERVICES PROGRAM

SNAP E&T AND VIEW JOB SEARCH FORM Important - Use this form to record the employer contacts and the number of hours for each contact you are required to make while you are looking for a job.

You do not need to get the signatures of the employer contacts, but your Employment Services Worker may verify these contacts.

You can count the hours that you spend in face-to-face interviews, the hours completing and turning in job applications or resumes, and the travel time between interviews (but not to the first interview each day or from the last interview each day).

[VIEW only] If you do not complete and sign each page of the form then return it to your Employment Services Worker by the due date, your TANF or TANF-UP benefits may be suspended. REMEMBER YOU MUST: [VIEW only] Spend at least hours per week looking for a job. From________________ (begin date) to _______________ (end date) [SNAP E&T only] Make at least ______ contacts per month looking for a job. From ________________ (begin date) to _______________ (end date)

Accept suitable job offers. Notify your Employment Services Worker as soon as you get a job. Complete and sign each page of the form and: Return the completed form to your Employment Services Worker by _____________________________ Keep this appointment with your Employment Services Worker on:

/

/

Date

Time

Address

AGENCY USE ONLY

Assigned hours for the month (VIEW) / Number of contacts for the month (SNAP E&T):

Holiday hours used for the month (Group Job Search only) - (VIEW ONLY)

Excused hours used for the month (Group Job Search only) - (VIEW ONLY):

Total countable hours of participation for this activity for the month - (VIEW ONLY):

Participant's Name: Case #: ESW: ESW Phone #: