Job Refusal Interview Ghosting Form

Job Refusal and Interview Ghosting

* = Required

Type of Incident: *

Job Refusal

Interview Ghosting

Date of the Refusal/Ghosting incident: *

Employer Name: *

Submitted By: *

Employer FEIN: *

Employer Phone Number: *

Employer Email Address: *

Employer Street:

Employer City:

Employer State:

Employer Zip: (5 digits)

First Name: *

Last Name: *

NOTICE: Claimant ID, SSN, Phone Number, Email, OR complete Mailing Address is required. *

Claimant ID: (up to 20 characters)

SSN: (9 digits)

Claimant Phone Number:

Claimant Email Address:

Street:

City:

State:

Zip: (5 digits)

Details: (up to 500 characters) *