New Hire Reporting Form - Nd Department Of Human Services

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NEW HIRE REPORTING FORM
ND DEPARTMENT OF HUMAN SERVICES
CHILD SUPPORT ENFORCEMENT
SFN 1018 (Rev. 11-2003)
Date:
Mail To:
Fax To:
Child Support Enforcement
Child Support Enforcement
ND Department of Human Services
ND Department of Human Services
OR
PO Box 7369
Fax #: (701) 328-5497
Bismarck, ND 58507-7369
Total Pages Faxed: ______________
Part 1: Employer Information (please print or type)
Employer Name:
For SDNH office use only.
Address:
City:
State:
Zip Code:
Federal Employer Identification Number:
Part 2: Employee Information (please print or type)
Employee Social
Employee Date of
Employee Date of
Employee Name
Employee Address
Security Number
Birth (optional)
Hire (optional)
1
2
3
4
5
(Use continuation sheet to report additional new hires.)
Employer Representative:
Telephone:
INSTRUCTIONS FOR COMPLETING THIS FORM MAY BE FOUND ON THE REVERSE SIDE
Page 25

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