- Your name
- Your email address
- Your phone number
- Company name
- EAN number
- Name of claimant you are inquiring about
Log in links for this page
- This page, Return to work employer complaint form, is offered by
- Department of Unemployment Assistance
Return to work employer complaint form
Employers can use this Department of Unemployment Assistance (DUA) form to report employees who refuse to return to work, suspected fraud, or inquire about other issues.