Company Name Payroll Processing Area Code Phone Number Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Addres ID: 855252
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1 Oklahoma New Hire Reporting Form O
Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number & Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number & Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number & Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number & Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number & Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number & Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number & Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number & Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number & Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number & Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number & Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number & Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number & Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number & Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number & Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number & Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number & Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number & Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number & Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number & Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number & Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52004http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 5200http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52003http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2004 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52003http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-200 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52003http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2003 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52003http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2003 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information Oklahoma New Hire Reporting Form OES112(12-04)Please fill out completely and mail to: Oklahoma New Hire Reporting CenterDownload a copy of this form at: (PRINT or TYPE Please!)PO Box 52003http://www.oesc.state.ok.us/newhire/Oklahoma City OK 73152-2003 OR FAX to:1-800-317-3786 or OKC Metro Area (405) 557-5350 Information Number: 1-800-317-3785 or OKC Metro Area (405) 557-7133Federal Employer Identification NumberOklahoma Account Number - - Company Name Payroll Processing Area Code, Phone Number Extension Payroll Processing Address Line 1CityState Payroll Processing Address Line 2Country Payroll Processing Address Line 3ZIP Code Social Security Number Occupation _ _ First NameMiddle 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 DayYear StateZIP Code Dependent health insurance available?- ‚ Yes‚ No Date of Birth Is this person currently employed with your company?MonthDayYear Yes No Employer Information New or Rehired Employee Information