New Jersey New Hire Reporting Form

New Hire Reporting Form
New Hire Report
New Jersey New Hire Reporting Form
Federal and state legislation (N.J.S.A. 2A:17-56.61) requires all New Jersey employers, both public and private, to report to the
state of New Jersey all newly hired, contracted, rehired, or returning to work employees. Information about new hire reporting
and online reporting is available on our website: www.nj-newhire.com.
To ensure the highest level of accuracy, please print neatly in
capital letters and avoid contact with the edges of the boxes.
The following will serve as an example:

Send completed forms to:
New Jersey New Hire Directory
PO Box 4654
Trenton, NJ 08650-4654
Toll-free fax: 1 (800) 304-4901

A

B

C

1

2

3

EMPLOYER INFORMATION
Federal Employer ID Number (FEIN) (Please enter the same FEIN used to report the employee's quarterly wages.):

Employer Name:

Employer Payroll Address:

Employer City:

Employer State:

Employer Phone (optional):

Extension:

Zip Code (5 digit):

Employer Fax (optional):

Email Address:

EMPLOYEE INFORMATION
Employee Social Security Number (SSN):

-

-

Is this employee an
Independent Contractor?

Yes

No

Employee First Name:

Middle Initial:

Employee Last Name:

Employee Address:

Employee City:

Date of Hire (MMDDYY):*

Employee State:

Zip Code (5 digit):

Date of Birth (MMDDYY):

Reports must be submitted within 20 days of date of hire or rehire. Failure to report could result in a fine.

REPORTS WILL NOT BE PROCESSED IF REQUIRED INFORMATION IS MISSING
Questions? Call us toll-free at 1 (877) NJ-HIRES

Rev (11/08)