Record information about all the jobs the claimant had in the five years before becoming
unable to work because of their medical condition(s), starting with their most recent
job first.
Include all job titles (even if they were for the same employer), self-employment,
and work performed in a foreign country. Do not include jobs that started and stopped
in fewer than 30 calendar days.
IMPORTANT: Some jobs may be performed differently from employer to employer. Therefore, it may
be necessary to provide separate descriptions for the same job title when the work
was for a different employer. For example, if the claimant was a "cashier" at three
different businesses and the job duties differed in each job, include three separate
descriptions in the job table. If the job duties and the physical and mental requirements
were the same, one entry is sufficient.
For each job, record:
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Job title: Enter the type of job performed. For example, "cashier."
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Type of business: For example, enter "grocery store" instead of the business name.
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Dates worked: Enter the month and year the claimant worked in this job.
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Hours per day: Enter the hours worked per day.
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Days per week: Enter the number of days worked per week.
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Rate of pay: Enter the Rate of pay and frequency. For example, if the claimant earned
$12.00 per hour, enter $12.00 in the "Rate of pay" field and check the frequency "hourly."
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Whether the claimant's job involved writing or completing reports.
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The physical and environmental requirements of each job. For example: how much bending,
sitting, walking, or related activity was required.
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Basic job duties and other descriptive data providing a complete picture of the nature
of duties the of the job performed; and
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