Guide to procedures in employment equality and pension cases 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Employee’s Information section. Clearly print the employee's name, former name, and Social Security Number if known.
3. Next, provide the contact information for the person completing the form. Include their name, telephone numbers, and address.
4. In the Employee’s Work History section, list all periods of employment chronologically. Start with the most recent job and include details such as facility name, location, type of employer, position title, and dosimetry badge information.
5. For each employer listed, describe work duties and any conditions that contributed to claimed illnesses. Indicate participation in health programs or unions as applicable.
6. Finally, complete the Declaration section by signing and dating the form to affirm accuracy.

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