Employment History Form


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Title Employment History Form
Description

Used to provide your employment history for the past three years, including self-employment and volunteer work.

Please start with your most recent job and work backwards. Please list any gaps or interruptions in your work history.  If you were unemployed at any time, please explain why.  Did you apply for (or receive) unemployment benefits during the time period? If yes, what dates did you receive unemployment benefits?  Did you seek employment during the time period?  If no, why didn’t you seek employment?

Document number F242-109-000
How to get this document
Keywords claims, employment records, espanol, industrial insurance, injury, previous, spanish, work history, worker's compensation, workers compensation, workers' compensation
Alt Language(s) Español
Valid dates 01/2006
Contact information Claims for Job Injuries
Websites Workers' Comp Claims

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