Fillable RELEASE OF EMPLOYMENT HISTORY LKE INSTRUCTIONS

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RELEASE OF EMPLOYMENT HISTORY LKE INSTRUCTIONS

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RELEASE OF EMPLOYMENT HISTORY
LKE INSTRUCTIONS
The Indiana Department of Workforce Development (IDWD) will release wage or employment history information to a third
party only via the Last Known Employer (LKE) website after submitting a completed copy of the attached release form. Please
login to your LKE account to submit requests for employment history. If you do not have a LKE account and the reason for
requesting employment history on behalf of a citizen is in compliance with IC 4-1-6-2(13)(B), you may apply for an account by
navigating to https://uplink.in.gov/lke
.
*Please Note:
• Non-IDWD forms will not be completed by IDWD staff.
• Unemployment insurance (UI) benefit information: Applicants who have had an Indiana UI claim can obtain benefit
information via their Claimant Self Service (CSS) account at uplink.in.gov/CSS/CSSLogon.htm. CSS support can be
reached by navigating to webapps.dwd.in.gov/AskWorkOne or calling 800-891-6499.
• Copies of IRS Form 1099-Misc: Applicants who have had an Indiana UI claim can obtain copies via CSS of Form 1099
issued by DWD for UI payments.
Information regarding employment history available via IDWD employer Unemployment Insurance Tax records:
• If complete wage and/or employment history records are needed, we recommend contacting the Social Security
Administration, Internal Revenue Service, or Indiana Department of Revenue.
• IDWD employer tax records do not include wages earned in other states or U.S. territories, income earned which was
or will be reported on a 1099-Misc Form (self-employment, contract employment, etc), or income earned through the
performance of non-covered or excluded services described in IC 22-4-8.
• Employers report wages to IDWD quarterly. Even timely reports are often 4-6 months in the arrears. The information
IDWD has available is employer, not employee, records for the purposes of assessing an employer’s Unemployment
Insurance Tax which is often not an accurate reflection of an individual’s complete income or employment history.
To help us provide timely responses, please ensure the following action is taken when submitting a request for employment
information via the LKE website:
• Use only the attached form. No other forms will be accepted or completed. Do not submit non-DWD forms.
• Ask applicants to provide all previously used names during employment on the IDWD approved release form.
• Confirm the form is complete, legible, and there are no corrected errors on the release form. If a mistake is made,
please complete a new form as an error on the form could result in the request being denied.
• A valid Social Security Number or Individual Tax Identification Number is required.
• Submit only one release form per appplicant request for employment history. Requests submitted with release forms
belonging to multiple applicants will be denied.
• Please do not submit duplicate requests. Submitting duplicte requests delays processing times and may result in
denial.
• Every effort will be made to respond to requests within 5 business days. Processing times may be longer during
periods of high volume.
Thank you,
Employement History Verification Unit
Indiana Department of Workforce Development
employverification@dwd.in.gov
RELEASE OF INFORMATION
*APPLICANT’S NAME: ________________________________________________________________________________
Additional names used during employment: _____________________________________________________________
*SOCIAL SECURITY or INDIVIDUAL TAX IDENTIFICATION NUMBER:
______-_____-_________
**Applicant contact information
Email Address: ______________________________________________Phone Number: _______-_______-__________
St
reet Address: _______________________________________________________________________________________________
City: _______________________________________________________________ State: ___________ Zip: ___________________
I authorize the Indiana Department of Workforce Development to release all wage and unemployment benefit information to
the
organization below.
____
_______________________________________________________ ____________________________
*SIGNATURE OF APPLICANT *TO
DAY’S DATE:
NOTE: RELEASE MUST BE SUBMITTED WITHIN 90 DAYS OF APPLICANT SIGNING RELEASE FORM.
Check this box if a Power of Attorney is attached.
------------------------------------------------------------------------------------------------------------------------------
NOTE: This section must be completed by the organization requesting employment history.
By signing below you agree that you understand that data we release to you is protected under state law (IC 22-4-19-6)
and federal regulations (20 CFR § 603.5) as confidential information. You also confirm that you have verified the
applicant’s identity by viewing some type of photo identification.
*SI
GNATURE OF REQUESTOR:
___________________________________________________________
*P
rinted Name of the Requestor:
________________________________________________________
* Requ
esting Organization:
____________________________________________________________
*E
mail Address:
____________________________________________________________________
*P
hone Number: _______-_______-__________ Fax Number: _______-_______-__________
*REQUIRED FIELDS
**Applicant’s phone number, email address, or mailing address is required.
Email employverification@dwd.in.gov to reach a DWD employment history or LKE website specialist.
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RELEASE OF EMPLOYMENT HISTORY LKE INSTRUCTIONS

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Completed 7 February 2022

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