Work History Checklist worksheet
Use this checklist to organize job titles, dates, duties, lifting, standing, skill level, and earnings.
| Item | Your notes |
|---|---|
| Use This Checklist To Organize Job Titles | ____________________________ |
| Dates | ____________________________ |
| Duties | ____________________________ |
| Lifting | ____________________________ |
| Standing | ____________________________ |
| Skill Level | ____________________________ |
| Earnings | ____________________________ |
| Employer or self-employment | ____________________________ |
| Month | ____________________________ |
| Gross earnings | ____________________________ |
| Hours worked | ____________________________ |
| Job duties | ____________________________ |
Before you use this checklist
- Copy dates and instructions from the current SSA notice rather than memory.
- Keep originals and work from copies.
- Do not send Social Security numbers, bank information, or full medical files to an unverified recipient.
- Save filing confirmations and proof of any time-sensitive submission.