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Document Number: DETW-14394
Description:This form is to be used to collect an individual's information when Job Center of Wisconsin or ASSET is not available.
Comments: Staff should enter collected information into ASSET and then scan and upload form into ASSET. Paper form should be shredded or otherwise destroyed confidentially.
Content Contact: Job Center of Wisconsin
Document Attachments:
DETW-14394 (English Print Version - Word/80 KB)
DETW-14394 (English Print Version - pdf/77 KB)
DETW-14394-S (Spanish Print Version - Word/80 KB)
DETW-14394-S (Spanish Print Version - pdf/124 KB)
Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.
DWD Contact Information
201 E. Washington Ave
P.O. Box 7946
Madison, WI 53707
(608) 266-3131
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