Form 6 - Utah New Hire Registry Reporting Form
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2DWS-UI
Form 6
UTAH NEW HIRE REGISTRY REPORTING FORM
Rev. 03/12
Utah New Hire Registry
>
Submit within 20 days
Photo Copy this Original for Future Use
P.O. Box 45247
>
Important Instructions on Reverse Side
of new employee's
Salt Lake City Ut 84145-0247
>
PRINT Legibly in Ink, or Type All Entries
first day of work to:
>
Please Write all Entries in CAPS
or FAX (801) 526-4391
>
All Required Items MUST Be Completed
INTERNET
REQUIRED EMPLOYER INFORMATION
1. Federal Employer
ID Number (FEIN)
2. Employer's
Name
3. Employer's Street
Address
4. Employer's
City
5. Employer's
6. Employer's
State
Zip Code
REQUIRED EMPLOYEE INFORMATION
7. Social Security
Number (SSN):
8. Employee's
First Name
9. Employee's
Middle Initial
10.Employee's
Last Name
11.Employee's Home
Address
12.Employee's
City
13.Employee's
14.Employee's
State
Zip Code
15.Date of Hire/Rehire
(Month/Day/Year)
OPTIONAL EMPLOYEE INFORMATION
16.Date of Birth
(Month/Day/Year)
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Parent category: Business