Florida New Hire Reporting Form
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1Florida New Hire Reporting Form
Page 1 of 1
FLORIDA NEW HIRE REPORTING FORM
Send completed form to:
Or fax to:
1.850.656.0528
Florida New Hire Reporting Office
or:
1.888.854.4762
P.O. Box 6500
For more information, call:
1.850.656.3343
Tallahassee, FL 32314-6500
or:
1.888.854.4791
Employer Information
Federal Employer
Identification No. (FEIN):
Employer UC Account No. (Also
known as UI Number):
Employer Name
Address
City/State/Zip Code+4
Contact Phone/Name
Employer Address for Income Deduction Orders
Address *
City/State/Zip Code+4
Contact Phone/Name *
Employee Information
Social Security Number
Employee Name
Employee Address
City/State/Zip Code
(please use four digit year)
Date of Hire
Date of Birth *
*Providing this optional data enhances our ability to perform services more efficiently.
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