Form C-61 Web - New Hire Reporting Form - 2010
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1Federal Identifi cation No.: ______________________________________
NEW HIRE
Employer Name:
______________________________________
REPORTING FORM
Employer Address:
______________________________________
Return to:
______________________________________
Vermont Department of Labor
ATTN: New Hire
______________________________________
P.O. Box 488
Montpelier, VT 05601-0488
This information may also be submitted through the internet at
FAX
the following address:
or
to: 802-828-4286
Date Employee
Actually Began
Working
Social Security No.
Employee Name
Address (Street, City/Town, State, Zip Code)
for
Compensation
NOTE: All new hires must be reported within 10 days of the date of hire, the fi rst day work is performed for compensation.
C-61 WEB (10/10)
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