Connecticut Department of Labor

UC-230 (Rev 11/2006) Name SSN

Week beginning Week ending
Report of Work-Seeking Activities Sunday Saturday
In order to be eligible for TRA benefits, the law requires that you make a thorough work search for each week claimed. You must a) actively seek work
throughout the week, b) make efforts to find work on at least two (2) days each week, and c) contact a minimum of three (3) employers each week.
The signature of prospective employers is NOT required; however, your work search is subject to verification by representatives of the Connecticut
Department of Labor. The efforts listed below must correspond with the dates of the claim week filed.
Date Employer name and address

Position/type of work sought Phone no./contact person, if known Method of contact Results of contact

Date Employer name and address

Position/type of work sought Phone no./contact person, if known Method of contact Results of contact

Date Employer name and address

Position/type of work sought Phone no./contact person, if known Method of contact Results of contact

Date Employer name and address

Position/type of work sought Phone no./contact person, if known Method of contact Results of contact

I certify that the information contained in this form is true and correct. I understand the law provides penalties for making false statements and withholding facts to
obtain benefits to which I am not entitled.
Signature Date

Connecticut Department of Labor

UC-230 (Rev 11/2006) Name SSN
Week beginning Week ending
Report of Work-Seeking Activities Sunday Saturday
In order to be eligible for TRA benefits, the law requires that you make a thorough work search for each week claimed. You must a) actively seek work
throughout the week, b) make efforts to find work on at least two (2) days each week, and c) contact a minimum of three (3) employers each week.
The signature of prospective employers is NOT required; however, your work search is subject to verification by representatives of the Connecticut
Department of Labor. The efforts listed below must correspond with the dates of the claim week filed.
Date Employer name and address

Position/type of work sought Phone no./contact person, if known Method of contact Results of contact

Date Employer name and address

Position/type of work sought Phone no./contact person, if known Method of contact Results of contact

Date Employer name and address

Position/type of work sought Phone no./contact person, if known Method of contact Results of contact

Date Employer name and address

Position/type of work sought Phone no./contact person, if known Method of contact Results of contact

I certify that the information contained in this form is true and correct. I understand the law provides penalties for making false statements and withholding facts to
obtain benefits to which I am not entitled.
Signature Date