Iowa Workforce Development - Unemployment InsuranceThis form is for Employers to report Unemployed Claimants in Iowa who have refused legitimate job offers. All fields below are required for a successful submission. Language Undefined Name of Business: * Employer Account Number * Business E-mail: * Worksite Street Address: * Worksite City, State, Postal Code: * Business Area Code+Telephone: * Your Name and Title: * Name Of Person Who Made The Job Offer: * First and Last Name Of Claimant : * Last 4 of Social Security Number * xxx-xx- Month and Day of Birth * Year18821883188418851886188718881889189018911892189318941895189618971898189919001901190219031904190519061907190819091910191119121913191419151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 Year MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day What did the claimant refuse? * Interview Job Offer Date of Job Refusal: * Starting Wage or Salary Offered: * How Was The Job Offer Made? * Please SelectIn PersonIn WritingBy PhoneBy Email or Other Electronic MeansOther Reason Given For Job Refusal: * Description Of Job Refused: * Name of person who offered the job interview? * Date the interview was offered? * Year20202021202220232024 Year MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Starting wage of the position? * $.00 Wage period? * - Select -HourlyBi-WeeklyMonthlyAnnually How Was The Job Interview Offered? * Please SelectIn PersonIn WritingBy PhoneBy Email or Other Electronic MeansOther Reason for interview refusal? * Job Description * Additional Information * Leave this field blank Send Job Offer Decline Form Business
