Form Enhr Rpt - New Hire Reporting Form

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TEXAS EMPLOYER NEW HIRE REPORTING PROGRAM
New Hire Reporting Form
• Please write all entries in CAPS • All items MUST be completed unless noted with an *
• PRINT legibly in ink, or type all entries • Further instructions are on reverse side
EMPLOYER INFORMATION
1. Federal Employer ID
2. State Employer ID
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Number (FEIN)
Number *
3. Employer’s Name
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4. Employer’s Address
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5. Employer’s City
6. State
7. ZIP Code
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8. Employer’s Payroll
Address (if different
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from above) *
10. State
11. ZIP Code
9. Employer’s Payroll
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City
12. Employer’s Telephone (|
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13. Employer’s FAX (|
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14. New Hire Contact Person*
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EMPLOYEE INFORMATION
15. Social Security
16. First Day of Work
Month
Day
Year (4 digits)
Number (SSN)
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(Mo/Day/Yr) *
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17. Employee
First Name
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18. Employee
Middle Name
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19. Employee
Last Name
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20. Employee
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Home Address
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21. Employee City
22. State
23. ZIP Code
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24. Employee
Foreign Address
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25. City
26. Country
27. Postal Code
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28. State Where Employee was hired*
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29. Employee DOB
Month
Day
Year (4 digits)
(Mo/Day/Yr)
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30. Employee’s Salary Dollars
Cents
31. Salary
“ Hourly
“ Biweekly
“ Monthly
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(Check One) “ Weekly
“ Semi-Monthly
“ Yearly
($ and cents) |
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*
Optional
Submit within 20 calendar days of new employee’s first day of work to
ENHR Operations Center, P.O. Box 149224, Austin, Texas 78714-9224
FAX: 1-800-732-5015, Phone: 1-800-850-6442
Online:
December 2005
ENHR RPT FORM

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