Form Tadj - Correction Of Wage Items - Alaska Department Of Labor

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EMPLOYER NUMBER
FEIN
EMPLOYER NAME
CORRECTION OF WAGE ITEMS
Alaska Department of Labor and Workforce Development
Division of Employment and Training Services
P.O. Box 115509, Juneau, AK 99811-5509
SOCIAL
EMPLOYEE
______ QTR. YR ______
______ QTR. YR ______
______ QTR. YR ______
______ QTR. YR ______
SECURITY
NAME
REPORTED
CORRECT
REPORTED
CORRECT
REPORTED
CORRECT
REPORTED
CORRECT
NUMBER
TOTALS:
EXPLANATION:
I CERTIFY that to the best of my knowledge, the foregoing information is true and correct.
Date:
By:
Title:
Telephone:
SOCIAL SECURITY NUMBER
SOC CODE
GEOGRAPHIC CODE
Provide the Social Security Number,
Standard Occupational Classification (SOC)
code and Geographic codes for employees
above not previously reported on the
Quarterly Contribution Report:
TADJ (6/17)

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