New Hire Reporting Form Texas

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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 Em ployer ID
2. State Em ployer ID
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Nu mb er (FE IN)
Num ber *
3 . E m plo ye r’s N am e
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4. Employer’s Address
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5. Em ployer’s City
6. State
7. ZIP Code
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8. Em ploy er’s Pa yro ll
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Address (if different
from abov e) *
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9. Em ployer’s Payroll City
10. State
11. ZIP Code
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12. E m ploy er’s T eleph one (|
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13. E m ploy er’s F AX (|
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14. N ew Hire Co ntac t Pe rson * |
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EMPLOYEE INFORMATION
15. Social Security
16. F irst Da y of W ork
Mon th
Day
Year (4 digits)
N u m be r ( SS N )
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(Mo /Da y/Yr) *
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17. Employee
F irs t N a m e
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18. Employee
M id dle N am e
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19. Employee
L as t N a m e
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20. Employee
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Home Address
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21. Em ployee C ity
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. S tate W here Em ploy ee w as h ired
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29. Employee DOB
Mon th
Day
Year (4 digits)
(Mo/D ay/Y r)
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30. Em ployee ’s Salary Dollars
Cents
31. Salary
Ho urly
Biw eek ly
M ont hly
($ and cents)
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(Check One)
W eek ly
Se m i-M ont hly
Ye arly
* 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 or call 1-888-839-4473
July 2004
ENHR RP T F ORM

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