Oklahoma New Hire Reporting Form

       

  

OES112(

03

-0

6

)

Please fill out completely and mail to:

Oklahoma New Hire Reporting Center

Download a copy of this form at:

(PRINT or TYPE Please!)

PO Box 5200

3

http://www.o

k.gov/oesc/

Oklahoma City OK 73152-200

3

OR FAX to:

1-800-317-3786 or

OKC

Metro Area

(405) 557-5350

I

nformation Number: 1-800-317-3785

or

OKC

Metro Area (405) 557-7133

Federal Employer Identification Number

Oklahoma Account Number

-

-

Company Name

Payroll Processing Area Code, Phone Number

      

Extension

Payroll Processing Address Line 1

City

State

Payroll Processing Address Line 2

Country

Payroll Processing Address Line 3

ZIP Code

Social Security Number

Occupation

_

_

First Name

Middle

Last Name

Starting Salary

$

?

 

Hour

?

 

Week

?

 

Commission / Other

?

 

Month

?

 

Year

Mailing Address

 

?

 

New Hire

  

?

 

Recalled

  

State of Hire

City

Date Started to Work or Recalled

 

     

Month

Day

Year

State

ZIP Code

   

Dependent health insurance available?

-

  

?

Yes

?

 

No

Date of Birth

Is this person currently employed with your company?

Month

Day

Year

?

 

Yes

  

?

 

No

Employer Information