Form UC-304: Work Search Record

To be eligible for UC benefits, complete the work search record for the week beginning Sunday through Saturday. Refer to your Pennsylvania UC Handbook (Form UCP-1) or go to www.uc.pa.gov for complete instructions or to print additional copies of this form. If you are working part-time, and earning more than your Partial Benefit Credit, initial here.

Under JOB APPLICATIONS/INTERVIEWS, for each of #1, #2 and #3 enter the Date of Application or Date of Interview, Employer, Employer Contact Name, Employer Phone/Email, How did you apply for the job and Results.

Under WORK SEARCH ACTIVITY, enter the Date of Activity, Type of Activity, Location of Activity, Contact Name and Contact Phone/Email.

Under EXEMPTION, enter the Name of Employer, Union Hiring Hall or Training Program and the Contact Name and Phone Number for Written Date of Recall (attach copy), Union Hiring Hall, Reemployment Services & Eligibility Assessment (RESEA) participants, Shared Work program participants or Trade Reduction Act participants.

By signing you certify that all information you have provided in this document is correct and complete, and you acknowledge that false statements in this document are punishable pursuant to 18 Pa.C.S. §4904, relating to unsworn falsification to authorities.

A person who knowingly makes a false statement or knowingly withholds information to obtain UC benefits commits a criminal offense under Section 801 of the UC Law, 43 P.S. §871, and may be subject to a fine, imprisonment, restitution and loss of future benefits.