NDOL | Refusal To Work Form

Refusal To Work Form

Under the law, if an unemployed person is offered a comparable job to their previous job at comparable wages and hours and refuses to accept the job offer, they will be disqualified from unemployment benefits. Employers are encouraged to report employment refusal by completing the form below.

The red asterisk (*) indicates required information

Your Company's Name

Your Name

Your Email

Your Phone Number

Worker's Name

What did the worker refuse?

Job offer

Interview

Other, please list:

Other Reason

Date of Refusal

Details