Criscuololaw.com/WorkSearch : Job Application Report
Dear clients of Vincent Criscuolo and Associates: You can use this form to record job applications to prove to the workers' compensation board that you are looking for work within your work restrictions. Please complete this form for each of your job application and use the NOTES section to explain why you applied for each job.
Email address
Your First Name
Your answer
Your Last Name
Your answer
What is your WCB#?
Your answer
What is the name of the employer you applied to?
Your answer
What date did you contact this employer?
MM
/
DD
/
YYYY
How did you contact this employer?
What position did you apply for with this employer?
Your answer
What is the employer's mailing address? (You can look up the address on Google if you don't know).
Your answer
Name and Title of Person Contacted if applicable. Or enter name of website where you applied.
Your answer
What is the employer's Daytime Phone # (You can look up the phone# on Google if you don't know).
Your answer
What is the employer's website? (Look up on Google if you don't know)
Your answer
What is the Confirmation # of your application, if you have one?
Your answer
What is the status of your application?
Would this job fit your physical restrictions?
What physical requirements are listed on the job posting, if any? For example, how much lifting, standing, bending, reaching, or sitting is listed as required?
Your answer
What education or experience do you have that qualifies you for this position?
Your answer
NOTES: Explain why you applied for this job and provide any other important details about this application.
Your answer
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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