Job Service

Reporting of Interview No Show or Refusal of Work Offered

SFN 61977

Employer Information
*Employer Business Name
*Employer Address
*City, State Zip	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Person Reporting Information
*First MI Last Name
*Phone Number	(222-333-4444)

Applicant Information
*First MI Last Name
*Phone Number	(222-333-4444)
Email	(email@host.com)
*Status	No Show for Interview Refused Offer of Work Unable to Contact for Interview, Offer Work, or Recall to Work

No Show for Interview Information
*Date of Interview	(mm/dd/yyyy)
*Date Applicant Notified of the Interview	(mm/dd/yyyy)
*How was the Applicant notified?	Text Message Letter Verbal-In Person Verbal-Via Telephone Email
*Did the Applicant confirm their attendance for the interview?	Yes No
*Did the Applicant contact you prior to the interview date to reschedule?	Yes No

Work Refusal Information
*Date Offer of Work was Made	(mm/dd/yyyy)
*Position Offered
*Summary of Position Duties
*Starting Date of the Work	(mm/dd/yyyy)
*Hourly Pay Rate Offered	$
*Reason the Applicant provided for refusing the work offered

Unable to Contact Information
*Reason for contact	Unable to Contact for Interview Unable to Contact for Offer Work Unable to Contact for Work Recall
*Date Contact Attempted	(mm/dd/yyyy)
Second Date Contact Attempted	(mm/dd/yyyy)
*Total Number of Attempts You Made to Contact the Individual
*Methods Used to Contact the Individual	Telephone    Text    Email    In Person    Other
Contact Phone 1	(222-333-4444)
Contact Phone 2	(222-333-4444)
Contact Phone 3	(222-333-4444)
Contact Email 1	(email@host.com)
Contact Email 2	(email@host.com)
Contact Email 3	(email@host.com)

*Required