Form Lwc 65W PDF Details

Maintaining eligibility for unemployment insurance benefits requires periodic reviews, especially for recipients actively seeking employment. The LWC 65W form plays a critical role in this process, as it is specifically designed to evaluate the continued eligibility of individuals receiving these benefits in Louisiana. By providing a detailed account of one's job search efforts, this form ensures that claimants are actively engaged in finding employment. The form asks for information regarding participation in any school or training programs, any barriers to employment such as lack of transportation or physical disabilities, and current employment status, including part-time work or self-employment. Additionally, it inquires about potential job prospects. Claimants must list their job contacts over the last three weeks, underlining the importance of consistent effort in job-seeking activities. The form, which can be filled out online and then printed for mailing or faxing, highlights the necessity for timely submission to avoid disqualification of benefits. Through questions that require thoughtful responses and a declaration of truth, the LWC 65W form underscores the shared responsibility between the individual and the Louisiana Workforce Commission in the unemployment benefits process. Penalties for false statements are a reminder of the importance of honesty in the maintenance of these benefits.

QuestionAnswer
Form NameForm Lwc 65W
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesbat adjusdication lwc, bat adjustments lwc la gov, bat adjudication lwc la gov email, bat adjudications lwc la gov

Form Preview Example

LWC 65W (07/09)

ELIGIBILITY REVIEW

___________________________________

________________________

Print Your Name

Your Social Security Number

To maintain your eligibility requirements for unemployment insurance benefits, a review of your work search record is required. When instructed, you must complete the items below and fax this form to (225) 346-6068 or mail this form to the Louisiana Workforce Commission, Adjudication Support Unit, P. O. Box 91253, Baton Rouge, LA 70821-1253. This form is semi-interactive and may be filled out online, then printed and mailed. Failure to return this form timely could result

in your being disqualified for benefits.

Answer the following questions:

 

 

 

 

 

 

 

 

 

 

 

 

1.

 

Are you attending any school or training program now? If so, list the name

 

 

 

Yes

 

No

 

 

of the school and the course of study:

 

 

 

 

___________________________________________________________

 

 

 

 

 

 

 

2.

 

Is there any reason why you cannot look for a job or accept one now?

 

 

 

Yes

 

No

 

 

(Such as a lack of transportation, a physical disability, pregnancy, childcare

 

 

 

 

 

problems, etc.)

 

 

 

 

 

 

 

 

3.

 

Are you working full-time, part-time, in self-employment, on a

 

 

 

Yes

 

No

 

 

commission basis, in operating a farm or as an elected official, etc?

 

 

 

 

 

4.

 

Do you have a definite prospect of employment? (In other words, have

 

 

Yes

 

No

 

 

you been given a date to begin work by a specific employer?) If so, list the

 

 

 

 

 

 

 

 

 

 

name of the employer and the date you will begin working.

 

 

 

 

____________________________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Record of work search or union contacts:

 

 

 

List one job contact you have made in each of the last three (3) weeks:

 

 

 

 

Date

 

Name of Company or Name of Union Officer Contacted

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Certification: I have answered these questions and provided a record of my work search contacts to obtain unemployment benefits. I know that this information is subject to verification and that the law provides penalties for false statements.

Your Signature:Today’s Date:

Please Print Your Mailing Address:

_____________________________________________

Your City, State and Zip Code:

_____________________________________________

Your Telephone Number:

_____________________________________________

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