New Hire Reporting Form
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1State of Illinois
Department of Employment Security
New Hire Reporting Form
Employers must report each new hire within 20 days.
Assistance: 1 800 327-HIRE (4473)
Please print or type
EMPLOYER NAME AND ADDRESS
Federal Employer ID Number - FEIN
-
Company Name
Street Address
Street Address
City
State
Zip Code
-
EMPLOYER ADDRESS FOR CHILD SUPPORT WAGE WITHHOLDING ORDERS
Street Address
Street Address
State
City
-
Zip Code
NEW EMPLOYEE NAME AND ADDRESS
Social Security Number
-
-
Date of Hire (MM-DD-YYYY)
MI
Last Name
First Name
Street Address
City
State
-
Zip Code
NEW EMPLOYEE NAME AND ADDRESS
Social Security Number
Date of Hire (MM-DD-YYYY)
-
-
MI
Last Name
First Name
Street Address
City
State
-
Zip Code
Return your completed form either by FAX 1-217-557-1947
or by mail to IDES, P.O. Box 19473, Springfield, IL 62794--9473
or report new hires online at
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Parent category: Business