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Report an employee who is currently working and receiving UI benefits
Name of person receiving unemployment benefits:
Last 4 digits of their SSN:
Their address:
Their date of Birth (mm-dd-yyyy):
Their Telephone number:
xxx-xxx-xxxx
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
there? (mm-dd-yyyy)
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 (
optional
):
Enter your phone number
xxx-xxx-xxxx (
optional
):
Enter your e-mail address (
optional
):
Enter your street address (
optional
):
Submit