Job Search Form - Service Canada

Service
Canada
PROTECTED WHEN COMPLETED - B
JOB SEARCH FORM
EI Claimant Information
Session Information
Name:
Date:
Social Insurance Number:
Location:
Time:
Telephone & Cell Numbers with Area Code:
Please give us the details of every job search effort you have made starting two weeks prior to the information session
date. To increase your chances of finding a suitable job, you must make ongoing job search efforts consistent with the job
opportunities of your community, with a focus and a real desire to obtain employment.
Job search efforts may include, but are not limited to:
• assessing employment opportunities;
• preparing a résumé or cover letter;
• registering for job search tools or with electronic job banks or employment agencies;
• attending job search workshops or job fairs;
• networking;
• contacting prospective employers;
• submitting job applications;
• attending interviews; and
• undergoing evaluations of competencies.
Type of job
search effort
Date
Details of your job search efforts
(e.g. job title, wage/salary, employer name,
address, phone number and email address)
Did you accept Did you reject
a job offer
a job offer?
(Yes/No)?
(Yes/No)
*Note: If you require additional space, please use another piece of paper and attach it to this form.
Service Canada delivers Employment and Social Development Canada programs and services for the Government of Canada.
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JOB SEARCH FORM
Type of job
search effort
Date
Details of your job search efforts
(e.g. job title, wage/salary, employer name,
address, phone number and email address)
PROTECTED WHEN COMPLETED - B
Did you accept Did you reject
a job offer?
a job offer?
(Yes/No)
(Yes/No)
*Note: If you require additional space, please use another piece of paper and attach it to this form.
Service Canada delivers Employment and Social Development Canada programs and services for the Government of Canada.
SC INS5240 (2013-05-003) E
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PROTECTED WHEN COMPLETED - B
JOB SEARCH FORM
DECLARATION
I declare that the information provided by me on this form is true to the best of my knowledge. I understand that this
information will be used to determine my eligibility for Employment Insurance benefits and/or to obtain Employment
Services, and my failure to provide this information may compromise my entitlement for Employment Insurance Benefits
and/or their programs and services.
Signature:
Date:
IMPORTANT
The information on this questionnaire is collected under the authority of the Employment Insurance Act and will be used
for determining your eligibility for benefits. The information you provide may also be used for policy analysis, research
and/or evaluation purposes. Please note that only those employees who need to have access to your personal
information will be authorized to do so. This information will be retained in the personal information bank ESDC PPU
150. Under the provisions of the Privacy Act and the Access to Information Act, individuals have the right to protection of
and access their personal information. Instructions for obtaining access to your personal information are provided in the
Info Source, a copy of which is located in Service Canada Centres. Info Source is also available at the following Internet
address, www.infosource.gc.ca.
You should be aware that the information you provide may be subject to verification and that there are penalties for
knowingly making false or misleading statements. You should also be aware that your personal information may be used
and/or disclosed under certain conditions as listed in the above-noted personal information banks, in accordance with the
provisions of the Privacy Act and the Employment Insurance Act.
Service Canada delivers Employment and Social Development Canada programs and services for the Government of Canada.
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