Work History Report Request

The Work History Report you will receive from this request is to be used as needed to comply with the California State Skilled and Trained Workforce (STW) requirement related to your employment for an employer signatory to I.U.O.E. Local 12. The Work History Report IS NOT a history of your accrued I.U.O.E. Local 12 Pension Credits and is not to be used to calculate your pension benefits. If you need a pension estimate please use the Pension Estimate Request Form available on the OEFI website, or call our Member Service Dept. at 866-400-5200.

Please note delivery of the Work History Report can take up to two (2) business days after your request is submitted.

Participant Information

SSN (last 4 digits)

Union Register No.

OE ID

SSN (last 4 digits) is required, and either your Union Register No. or OE ID

Birth Month

Birth Day

First Name May only contain letters.

Delivery

How would you like your Work History Report sent to you?

Email

Postal Service (USPS)

Email and Postal Service (USPS)

Email Address Required for either delivery method.

I understand that by checking this box I acknowledge that I am the signee and that entering my name in the Electronic Signature field constitutes a legal signature. Further, I warrant and agree that I am duly authorized to sign and that the information I entered on this form is correct to the best of my knowledge.

I hereby certify under penalty of perjury that the foregoing statements are true and complete to the best of my knowledge.

E-Signature Full legal name required, including first and last name.

Today's Date

SSN (last 4 digits)

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Work History Report Request

Participant Information

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Local 12

So. Cal. Training Trust

Southern California Surveyors Joint Apprenticeship Committee

Southern Nevada Training Trust

I.U. OF OPERATING ENGINEERS