OUTSIDE JOB SEARCH CONTACT LOG Due

OUTSIDE JOB SEARCH CONTACT LOG
Due
ParƟcipant : _____________________________________________________________ Client/Recipient ID:_______________________
Date: _______________________ (First & Last Name)
MW! ^ƚĂĨĨ Name: ______________________________________________________________________________
(Please Print)
Time:_______________________ Week Begin Date (Sunday) : ________________________________Week End Date (Saturday): _________________________________
Date
Mileage
(See case manager)
Employer Name
& Phone Number
Employer Address or
Website Address
AcƟvity (circle one)
Actual Time Spent
(check one)
Interview Applica on □ 15 Min
□30 Min
□ 45 Min
□60 Min
Resume Follow‐up Internet Other______________ □ If more than 1 hr
Interview Applica on □ 15 Min
□30 Min
□ 45 Min
□60 Min
Resume Follow‐up □ If more than 1 hr Internet Other______________ Interview Applica on □ 15 Min
□30 Min
□ 45 Min
□60 Min
Resume Follow‐up □ If more than 1 hr Internet Other______________ Interview Applica on □ 15 Min
□30 Min
□ 45 Min
□60 Min
Resume Follow‐up Internet Other______________ □ If more than 1 hr Interview Applica on □ 15 Min
□30 Min
□ 45 Min
□60 Min
Resume Follow‐up Internet Other______________ □ If more than 1 hr Interview Applica on □ 15 Min
□30 Min
□ 45 Min
□60 Min
Resume Follow‐up □ If more than 1 hr Internet Other______________ Interview Applica on □ 15 Min
□30 Min
□ 45 Min
□60 Min
Resume Follow‐up □ If more than 1 hr Internet Other______________ ParƟcipant Signature:___________________________________________________
By signing above, I agree that the informaƟon I provi
ded is true to the best of my knowledge.
WR-204 w/mileage (Revised Date: 10/01/14)
Equal Opportunity Employer/Service Provider. Michigan Relay Center (800) 649
Equal Opportunity Employer/Service Provider. Michigan Relay Center (800) 649‐‐3777. Auxiliary Aids and Services Available to Individuals with Disabili
3777. Auxiliary Aids and Services Available to Individuals with Disabili es. Total Hours Above: _________
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