Report an employee refusing to return to work - Louisiana Workforce Commission

We put people to work.

(*) Entry Required

* Company name:
* Company Unemployment Employer Account Number (EAN):
* Name of company contact submitting form:
* Contact title:
* Contact daytime phone number: (###-###-####)
* Contact e-mail address:

* First name of individual who refused to return to work:
* Last name of individual who refused to return to work:
* Full SSN of individual who refused to return to work:

* Date return to work was offered to individual above:
* Was a written offer given to the individual?
Yes
No
* Select job type:
Full-time (30 hours or more)
Part-time
Temporary
* Was this individual previously employed by you?
Yes
No

* What was the salary of the individual’s most recent job with your company?
      * List the hours and days the employee previously worked:
      Answer only if #13 is 'YES'
     Character Count: (Max 100, remaining 100.)
      * How did this offer of employment differ from other employment the
          employee had in the past 18 months?
      Answer only if #13 is 'YES'
     Character Count: (Max 200, remaining 200.)

* List the hours and days the employee would have been scheduled to work:

Character Count: (Max 100, remaining 100.)
* Date individual above refused to return to work:
* Did the employee quit?
Yes
No
      * Date employee above quit:
            (Answer only if #19 is 'YES'.)

* What reason did the employee give you for refusing to return to work?

Character Count: (Max 200, remaining 200.)
* Are you holding the job for the individual?
Yes
No

* Was your business deemed an essential business during COVID-19?
Yes
No
      * What date did your business reopen?
            (Answer only if #23 is 'No'.)
* Has your business complied with all occupancy limits, sanitation guidelines and
spacing for physical distancing as outlined in White House COVID-19 guidance?
Yes
No