JOB SEARCH ACTIVITY LOG
Name: ___________________________________
Case Number:
The person presenting this form is required to show what efforts are being made to secure employment.
Even if employment is not available, we appreciate your cooperation in verifying this effort.
(Please place a √ in the application, interview or follow-up column for each business listed)
Date
Business name, address, and
telephone number
Application
Interview
Follow
up
Signature & Print Name of
Agent of Employer
I declare that the statements above are true to the best of my information, knowledge, and belief. [MCR2.144(A)]
A person who knowingly makes a false declaration may be held in contempt of Court.
Date:
Signature
PLEASE RETAIN A COPY OF THIS JOB SEARCH ACTIVITY LOG FOR YOUR RECORDS
Revised 12/9/2009