OBJECTIVE:: The healthy worker effect implies that healthy workers go "up" in employment status whereas less healthy workers go "down" into precarious temporary employment or unemployment. These hypotheses were tested during an economic recession, by predicting various upward and downward contract trajectories, based on workers' health status, work-related well-being, and work ability. METHODS:: Two waves (2008 and 2009) of the Netherlands Working Conditions Cohort Study (N = 7112) were used and logistic regression analyses were performed to test the hypothesis of this study. RESULTS:: Lower general health and higher emotional exhaustion at baseline predicted future unemployment among permanent employees. Various downward trajectories were also predicted by lower work-related well-being and lower work ability, whereas the opposite was true for one of the upward trajectories. CONCLUSIONS:: Workers with lower health, lower work-related well-being, or lower work ability are at risk for ending up in precarious temporary employment or unemployment. Copyright © 2012 by American College of Occupational and Environmental Medicine.