Iowa Workforce Development - Unemployment Insurance This 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 * Year18811882188318841885188618871888188918901891189218931894189518961897189818991900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023 Year MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day 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: * Leave this field blank Send Job Offer Decline Form
