Report an employee who is currently working and receiving UI benefits
Name of person receiving unemployment benefits:
Last 4 digits of their SSN:
Their date of Birth (mm-dd-yyyy):
Their Telephone number:
Working full time or part time?
Where are they working?
What kind of work is he/she doing?
Is he/she working at a business other than yours?
When did he/she start working
Provide a brief description of your concerns:
Please enter your contact information in case we need to contact you.
This is optional
and will be kept confidential.
Enter your name (
Enter your phone number
Enter your e-mail address (
Enter your street address (