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Form Bls 3023-Nvm - Industry Verification Form - Oklahoma Employment Security Commission

Oklahoma Employment Security Commission

Economic Research & Analysis Division/ARS

Industry Verification Form, BLS 3023-NVM

P.O. Box 52003

Form Approved, O.M.B. No. 1220-0032

Oklahoma City, OK 73152-2003

Expiration Date: 12/31/2017

In cooperation with the U.S. Department of Labor

Phone: (405) 557-5407

Toll Free In-State: (800) 523-5994

FAX: (405) 525-0139

Unemployment Insurance Account Number:

________________________________________ in Oklahoma.

This report is mandatory under OESC rule 240:10-5-92 , and is authorized by law, 29 U.S.C. 2. Your cooperation is

needed to make the results of this survey complete, accurate, and timely. Purpose, use and help information are

located on the back of this form.

We appreciate your response within 14 days. Thank you.

BUSINESS MAILING ADDRESS

Please print.

Business Name: _______________________________________________________________________________

Street Address: ________________________________________________________________________________

City: __________________________________________________ ST: ___________________ ZIP: __________

MAIN BUSINESS ACTIVITY OF EACH LOCATION ADDRESS

In Section A, please provide a list of all worksites of your business within the state. Please make sure to

provide the physical location address for each worksite, along with a brief description of the main business

activity at each location. Further instructions are printed in Section A.

CONTACT INFORMATION

Name: _______________________________________________________

Date: ____________________

Title: ________________________________________________________

Phone: ___________________

Email: _____________________________________________________________________________________

Website: ___________________________________________________________________________________

You may return this form via FAX: (405) 525-0139 or by mail:

Oklahoma Employment Security Commission

Economic Research & Analysis Division/ARS

P.O. Box 52003

Oklahoma City, OK 73152-2003

Form Bls 3023-Nvm - Industry Verification Form - Oklahoma Employment Security Commission