Document Number: UCB-18102-E
Description: Use this form to notify the Department of Workforce Development, Unemployment Insurance (DWD/UI) of a conditional offer of work that required a drug test and the offer was rescinded due to:
Comments: This form can be filled out on the computer as a fillable pdf. It should be printed and signed, then mailed or faxed to Unemployment Insurance, P.O. Box 7905, Madison, WI 53707. The Fax Number is (608) 260-2506.
Content Contact: Benefit Operations Staff
Document Attachment: UCB-18102-E (Electronic Version - pdf/19 KB)
NOTE: When using Google Chrome, you may notice overlapping text when you select file, print. Deselect the 'fit to page' option and the text will no longer overlap.
Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.