Form SSA-3369-BK, Work History Report is a form used for providing the Social Security Administration (SSA) with detailed information about all jobs you performed in the past 15 years. The latest version of the form - also known as the SSA Form 3369-BK - was released by the SSA on April 1, 2014. The previous editions of this document are obsolete. A Form SSA-3369-BK fillable version is available for download below.
The SSA Work History Report is an important part of your application for Social Security disability benefits. It helps the SSA to obtain detailed information about any employment you had had in the last 15 years before you became unable to work due to an injury, illness, or a particular condition. This document informs the SSA about the type of job you held, specific skills and experience you gained, and mental and physical requirements each of the positions demanded. The agency needs these details to make sure that you can no longer perform the duties you performed on your previous jobs, and have no skills or knowledge to find work in any other area.
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