SSA-3369 Form Helper
Complete your Work History Report (SSA-3369-BK)
Applicant Information
This is the date your medical conditions stopped you from working. The SSA looks at the 15 years prior to this date, but this form specifically asks for details on jobs in the 5 years before this date.
Work History
List jobs you held in the 5 years before you became unable to work. Do not include jobs held for less than 30 calendar days.