Employer Information - Maryland New Hire Registry
ADVERTISEMENT
1MARYLAND NEW HIRE REGISTRY
-
Please Make All Entries in CAPS
-All Required Items 1-7 and 11-20 MUST Be Completed
- Print Legibly in Ink or Type All Entries
EMPLOYER INFORMATION
ITEMS 1-7 ARE REQUIRED INFORMATION
1. State Unemployment
2. Federal Employer ID
Insurance Number
Identification Number
(FEIN)
3. Employer’ s Name
4. Employer’ s Address
5. Employer’ s City
6. State
7. Zip
Codes
8. Employer’ s Telephone
9. Employer’ s Fax
10. New Hire Contact Person
EMPLOYEE INFORMATION
ITEMS 11-20 ARE REQUIRED INFORMATION
11. Social Security
12. First Day of Work
Month
Day
Year (4 digits)
Number (SSN)
(MM/DD/YYY)
13. Employee’ s First Name
14. Employee’ s Middle Name
15. Employee’ s Last Name
16. Suffix (if
applicable)
17. Employee’ s Home Address
18. Employee’ s City
19. State
20. Zip
Code
21. Employee Sex
22. Employee’ s Date of Birth
Month
Day
Year (4 digits)
-M for Male
(MM/DD/YYY)
-F for Female
23. Employee Salary
Dollars
Cents
24. Are health care benefits
($ and cents)
available to employees?
-Y for Yes
-N for No
25. Salary Rate
Within 20 calender days of new employee’ s first day of work to:
Maryland New Hire Registry
P.O. Box 1316
Baltimore, MD 21203-1316
Fax: (410)347-5993 or (888)657-3534
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business