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Report Refusal of Suitable Work

Name: *
Email: *
Messages:

INSTRUCTIONS: Complete this form if you have offered work to an individual who is receiving unemployment benefits, and that person turned down the offer of work.
Your business name: *
Your Unemployment Employer Account Number (EAN):
Your Federal Employer Identification Number (FEIN): *
Last name of individual offered work: *
First name of individual offered work: *
Individual's Social Security Number (Last four digits): *
Person completing this request (Name/Title): *
Telephone number of person completing this request: *
Email address of person completing this request: *
Who made the offer of work? (Name/Title): *
Date work was offered: *
How was the individual contacted to make the offer? (Check all that apply): *

Email Phone In Person Mail Other
If Other, please explain:
What type of work was offered?: *
Indicate city/town/state and division/unit of the work offered: *
Was the work offered: *

Full-Time Part-Time
Indicate the number of hours per week and shift of the work offered: *
Indicate the rate of pay for the offered work: *
Indicate the date work was to start: *
Indicate the reason(s) given by the individual for refusing the offer of work: *
Was the individual employed with you before?: *

Yes No
If yes, please answer the following:
What was the previous job, rate of pay, and the last day of that work?:
Where was the previous work performed?:
By submitting this form, you acknowledge that all information provided is true and accurate to the best of your knowledge. You further agree that New Mexico Department of Workforce Solutions (NMDWS) may use this information to complete the Initial Refusal of Suitable Work Fact Finding Questionnaire on your behalf on your Unemployment Insurance employer account.

Additional fact finding may be required to complete this investigation and will be sent to you by your preferred correspondence preference. Please respond to any requests for information no later than 10 days from the date the request was sent. If a response is not received before the deadline, NMDWS will proceed with the investigation based on the information on hand at the time.