Rhode Island Directory Of New Hires Reporting Form
ADVERTISEMENT
1RHODE ISLAND DIRECTORY OF NEW HIRES REPORTING FORM
Mailing Address: RI State Directory of New Hires
Toll Free Fax:
1-888-430-6907
P.O. Box 540220
Web Address:
Omaha, NE 68154-0220
TO ENSURE ACCURACY, PLEASE PRINT (OR TYPE) NEATLY IN UPPER-CASE LETTERS AND NUMBERS, USING A
DARK BALL-POINT PEN
REQUIRED EMPLOYER INFORMATION
Federal Employer Identification
Number (FEIN)
Employer Name
Employer Address 1
Employer Address 2
Employer Address 3
Employer City
Employer State
Employer Zip Code
Employer Payroll Address 1
(if different than employer address)
Employer Payroll Address 2
Employer payroll City
Employer payroll State
Employer payroll Zip code
REQUIRED EMPLOYEE INFORMATION
Employee SSN
Employee First Name
Employee Middle Name
Employee Last Name
Employee Address 1
Employee Address 2
Employee Address 3
Employee City
Employee State
Employee Zip Code
Does Employee qualify for health
If Yes, provide the date the employee qualifies for health insurance
insurance?
_____Y/N
___ ___ ___ ___ ___ ___ ___ ___ MMDDYYYY
OPTIONAL INFORMATION
Employee Date of Birth
___ ___ ___ ___ ___ ___ ___ ___ MMDDYYYY
Employee State of Hire
___ ___
Employee Date of Hire ___ ___ ___ ___ ___ ___ ___ ___ MMDDYYYY
THIS FORM MAY BE REPRODUCED AS NECESSARY.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business