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05/21/2025

Reporting of Interview No Show or Refusal of Work Offered

SFN 61977

Employer Information
*Employer Business Name
*Employer Address
*City, State Zip

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
*Date Applicant Notified of the Interview
*How was the Applicant notified?
*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
*Position Offered
*Summary of Position Duties
*Starting Date of the Work
*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
Second Date Contact Attempted
*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

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