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Employment History Form Spanish Formulario de Historial de Empleo

Used by injured worker to report their employment history for the past three years and the wages at each job.



Form
F242-109-999



Alt Language(s):
Inglés
 
Employment History Form

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?



Form
F242-109-000



Alt Language(s):
Español
 
Occupational Disease Work History - Continuation

This is a continuation page to the Occupational Disease Work History (F242-071-000) to add additional work history.



Form
F242-071-111



Alt Language(s):
Español
 
Vocational Questionnaire/Work History - Spansih CUESTIONARIO VOCACIONAL/HISTORIA DE TRABAJO

Vocational Questionnaire/Work History for use by Vocational Providers serving injured workers



Form
F280-038-999


 
Vocational Questionnaire/Work History

Vocational Questionnaire/Work History for use by Vocational Providers serving injured workers.



Form
F280-038-000



Alt Language(s):
Español
 





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