Employee Work Refusal Documentation

To help identify the individual who may be receiving unemployment benefits, adding a social security number is highly preferred. Although appropriate action will be taken with those individuals currently receiving unemployment benefits, not all submissions will trigger a call or return correspondence.

Employers can also visit WorkInTexas.com and follow the instructions for reporting why an applicant wasn’t hired.

Indicates required information

Employer Information

Employer Name

Employer Account Number

Employer Point of Contact Name

Employer Point of Contact Phone

Claimant Information

First Name

Middle Initial

Last Name

Claimant Social Security Number

Date of Job Offer or Interview

Job Offer Method

Position Offered

Work Schedule

Were the wages, hours, or conditions of the work offer same as past?

Rate of Pay

Reason for Refusal

Refusal Other Description

If the person refused the job due to a reason not listed, select "Other" from the Reason for Refusal drop-down menu, and give a short description in the Refusal Other Description.