Training Benefits Work History Form Page 2
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1
2Next Employer
Job Title
I worked for this employer
Mailing Address
City
State
ZIP
From _______ / ______ / ______ To _______ / ______ / ______
Month
Day
Year
Month
Day
Year
Reason you are no longer working
1 _ Voluntary Quit
4 _ Still Employed
7 _ Fired for Felony/Gross Misdemeanor
My hourly/monthly pay for
My total earnings for this
for this employer:
2 _ Fired
5 _ Lack of Work
8 _ Partially Employed
this period of employment
period of employment
(Check One)
was $________________
was $________________
3 _ Strike/Lockout
6 _ Leave of Absence
9 _ Lack of Work, Reduced Hours
Job Description
(did what,
using what, to what?)
Next Employer
Job Title
Mailing Address
City
State
ZIP
I worked for this employer
From _______ / ______ / ______ To _______ / ______ / ______
Month
Day
Year
Month
Day
Year
Reason you are no longer working
1 _ Voluntary Quit
4 _ Still Employed
7 _ Fired for Felony/Gross Misdemeanor
My hourly/monthly pay for
My total earnings for this
for this employer:
this period of employment
2 _ Fired
5 _ Lack of Work
8 _ Partially Employed
period of employment
(Check One)
was $________________
was $________________
3 _ Strike/Lockout
6 _ Leave of Absence
9 _ Lack of Work, Reduced Hours
Job Description
(did what,
using what, to what?)
Next Employer
Job Title
Mailing Address
City
State
ZIP
I worked for this employer
From _______ / ______ / ______ To _______ / ______ / ______
Month
Day
Year
Month
Day
Year
1 _ Voluntary Quit
4 _ Still Employed
7 _ Fired for Felony/Gross Misdemeanor
My hourly/monthly pay for
Reason you are no longer working
My total earnings for this
for this employer:
this period of employment
2 _ Fired
5 _ Lack of Work
8 _ Partially Employed
period of employment
(Check One)
was $________________
was $________________
3 _ Strike/Lockout
6 _ Leave of Absence
9 _ Lack of Work, Reduced Hours
Job Description
(did what,
using what, to what?)
Next Employer
Job Title
Mailing Address
City
State
ZIP
I worked for this employer
From _______ / ______ / ______ To _______ / ______ / ______
Month
Day
Year
Month
Day
Year
Reason you are no longer working
1 _ Voluntary Quit
4 _ Still Employed
7 _ Fired for Felony/Gross Misdemeanor
My hourly/monthly pay for
My total earnings for this
for this employer:
2 _ Fired
5 _ Lack of Work
8 _ Partially Employed
this period of employment
period of employment
(Check One)
was $________________
was $________________
3 _ Strike/Lockout
6 _ Leave of Absence
9 _ Lack of Work, Reduced Hours
Job Description
(did what,
using what, to what?)
3
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