Reporting Potential Unemployment Fraud

Name of Person:

Person's address:

Person's City, State, and Zip Code:

Person's phone number:

What is the nature of their violation? (Why shouldn't they be getting unemployment?)

If the individual is working, please answer the following:

Name of employer:

Full Address the employer (at least of the city):

Phone number:

When did the claimant start working:

What job are they doing:

What hours do they work:

How do you know they are getting paid:

If the individual is sick, in jail or otherwise not able to work.

When did this happen:

What exactly is their restriction:

Who else knows the individual is doing this and can give us information:

Although not required, we appreciate having your name address and phone number because we may have more questions that we would like to ask

Your Name:

Your Address:

Your Phone Number: