Licenciado

|UIB-1128A FORNA (8-10) |ARIZONA DEPARTMENT OF ECONOMIC SECURITY | |
||Unemployment Insurance Administration | |
| |CONTINUED CLAIM FOR EXTENDED BENEFITS| |
|NAME | |SOCIALSECURITY NUMBER | |WEEK ENDING DATE |
| | | | ||
| |
|ANSWERTHESE QUESTIONS FOR THE WEEK THAT ENDED ON THE DATE ABOVE |YES |NO |
|Were you able to work and available for workeach regular workday? | | |
|Did you look for work? (You MUST report your work search below.)| | |
|Did you refuse any job offer or referral to work?| | |
|Did you work or earn any money? (If YES, you MUST answer 4a and 4b.) | ||
| |DOLLARS | |CENTS | | | |
|What were your gross...