Get Employment History Affidavit, Form Ee-4 - The University Of Iowa ... - Cph Uiowa

The Employment History Affidavit, Form EE-4 is crucial for affirming the employment history of individuals related to claims filed under the Energy Employees Occupational Illness Compensation Program Act. This guide offers step-by-step instructions on how to accurately fill out this form online, ensuring clarity and ease throughout the process.

Follow the steps to complete the Employment History Affidavit accurately.

1. Press the ‘Get Form’ button to obtain the Employment History Affidavit, Form EE-4 and open it in your editor.
2. Begin with the employee's information section. Clearly print the employee’s name in the fields provided, including the last name, first name, and middle initial. Ensure this information is accurate as it is essential for the claim.
3. If applicable, fill in the maiden or former name of the employee. Next, enter the social security number if known, as this is important for identification purposes.
4. Continue to the your information section. Clearly print your name, telephone numbers, and address. Ensure that your contact information is current and complete.
5. Indicate your relationship to the employee by checking all relevant options, such as work associate, spouse, or friend. This helps establish your connection to the employee's work history.
6. Start detailing the employee's work history. Begin with the most recent employer and provide all requested information, including the employer's name, city/state, and dates of employment. Use separate sheets if more space is needed.
7. For each employer listed, describe the type of work the employee did in detail, including their title and duties. Be as specific as possible, as this information supports the claim.
8. In the section on how you know the employee's work history, provide any necessary context for your knowledge of their employment. If you worked with the employee, include your position and the dates you worked together.
9. Repeat this process for additional employers as necessary, following the same detailed instructions for each entry.
10. Finally, complete the declaration section. Sign and date the form, affirming that all provided information is accurate and true. This is crucial as any false statement may result in legal consequences.
11. Once all sections are filled out, you can choose to save your changes, download the form, print it out, or share it as needed.

Complete your Employment History Affidavit online today to ensure your claims are processed without delay.