Form C-61 Web - New Hire Reporting Form

Federal Identification 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:

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 shall be reported within 10 days of the date of hire, the first day work is performed for compensation.

All rehires shall be reported if they were previously employed by the employer but have been separated from such

employment for at least 60 consecutive days.

C-61 WEB (10/16)

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Parent category: Legal