TAA-861 (Rev.

5/2005)
Connecticut Department of Labor
Request for Job Search Allowance
Trade Act of 1974, as amended
Worker’s Name (Last, First, Middle) Social Security No. Job Center Date

Address Petition No. Company Paying

State

Is this worker’s first request for

Date of total separation from adversely affected employment
job search allowance?

Section A. Worker Request

A job search allowance shall be granted to an adversely affected worker to assist the individual in securing a job within the United
States. An application may be submitted to a state agency at any time by an individual who has been totally or partially separated
whether or not a certification covering the individual has been made; however, an application must be submitted to the state agency
before the job search begins for the job search allowance to be granted, and the job search may not be approved until after the
individual is covered under a certification. The applicant must be totally separated from adversely affected employment at the time the
job search commences. A job search allowance application may be approved only if submitted before (1) The 365th day after the date
of the certification under which the individual is covered, or the 365th day after the date of the individual's last total separation,
whichever is later; or (2) The 182d day after the concluding date of Trade Act-approved training. If approved, completion of the job
search must occur within a reasonable period not exceeding 30 days after the day on which the job search began. A job search is
deemed completed when the individual either secures employment or has contacted each employer to whom referred by the State
agency in connection with a job search. The State agency shall verify contacts with employers certified by the individual.
Job search allowance is requested to attend the following interview:
If multiple interviews, check here ____ and provide additional details on reverse side.
Name and address of firm Date of Position(s) for which you will be
interview considered. Provide job title(s).

Name, address (if different from above), phone and email of the firm representative with whom you arranged the interview.

Date and time of Departure: Return:

Travel method and cost Auto Commercial carrier
Round trip Type Cost
Mileage
If the individual is covered under a certification, a state agency may advance 60 percent of the estimated amount of the
job search allowance payable on completion of the job search, but not exceeding $360, within five days prior to the
commencement of a job search. Such advance shall be deducted from any payment due.
Do you request advance payment? Yes No (Note: Adequate processing time is required in order to grant request.)
Will you be entitled to receive payment or reimbursement for job search expenses from any other
Yes No
source? (i.e., employer to pay for hotel, flight, etc.) If yes, explain on reverse side.
The information contained in this request is correct and complete to the best of my knowledge. I understand that penalties
are provided for willful misrepresentation made to obtain allowances to which I am not entitled.

Signature ______________________________________________________________ Date _____________________

Section B. Certification by TAA Counselor

Has the individual registered for appropriate reemployment services? Yes No
Does the individual have a reasonable expectation of securing suitable* employment in the local
Yes No
commuting area? If no, why not? _______________________________________________________
__________________________________________________________________________________
Is there a reasonable expectation of obtaining suitable* employment of long-term duration outside the Yes No
commuting area and in the area where the job search will be conducted?
Has the worker submit this application timely (see Section A) and before beginning the job search? Yes No
Job search allowance is recommended not recommended.
Signature of TAA representative ____________________________________________________ Date _____________
*Suitable employment -- for the purposes of job search allowance -- means suitable work as defined in the applicable state law for
claimants for regular compensation or suitable work as defined in applicable state law provisions consistent with section 202(a)(3) of the
Federal-State Extended Unemployment Compensation Act of 1970, whichever is applicable; it does not in any case include self-
employment or employment as an independent contractor.