Form DWS-ESD630 "Employment Information" - Utah

What Is Form DWS-ESD630?

This is a legal form that was released by the Utah Department of Workforce Services - a government authority operating within Utah. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2020;
  • The latest edition provided by the Utah Department of Workforce Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DWS-ESD630 by clicking the link below or browse more documents and templates provided by the Utah Department of Workforce Services.

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Download Form DWS-ESD630 "Employment Information" - Utah

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DWS-ESD 630
State of Utah
Rev. 04/2020
Department of Workforce Services
EMPLOYMENT INFORMATION
Case name:
Case number:
Employed person:
SSN:
For new, changes, and returning employment, the entire form must be completed
D11120900160101
and signed by the employer. Please use a black pen to complete form.
Employer Information:
Company name:
Corporate name (if different):
Payroll company (if different):
Company address:
Name of supervisor or HR contact:
Phone number:
Employee Information:
1. Date employment began, changed, or returned to work after leave of absence:
2. Is the employment temporary?
Yes
No If yes, what is the expected end date?
3. Is the employment considered Educational Work Study?
Yes
No
4. Hourly wage: $
/hr. or Salary: $
/Monthly
/Yearly
5. Will the number of hours worked each week vary?
Yes
No
If yes, minimum hours:
Maximum hours:
If no, list the number of hours worked each week:
6. Are there months where this employee works more or less than the hours reported in question 5?
Yes
No If yes, which months and how many
(e.g., a teacher who does not work during the summer)
hours will the employee work each week?
7. Is overtime offered on a regular basis?
Yes
No
Weekly overtime hours:
Overtime rate: $
8. How often paid?:
Every two weeks
List day of the week paid:
(e.g., every other Friday)
Twice per month
List dates:
(e.g., 5th and 20th)
Weekly
Monthly
Other:
9. Date first paycheck will be (or was) received:
What is the estimated gross amount
? $
Hours paid on the first check?
(before taxes)
10. When does the pay period end
?
(e.g., every other Friday or 15th and 30th)
11. Does employment include tips, commission, health savings account or shift differential?
Yes
No
If yes, list amount and frequency:
12. Does employment include bonuses
?
Yes
No
(e.g., holiday, profit-sharing, performance, etc.)
If yes, list amount and frequency:
13. Does the employer offer health insurance?
Yes
No
Is the employee eligible to enroll?
Yes
No
If no why:
14. If terminated, list the termination date:
Date of final pay check:
Employer Signature*
Date
*Additional verification will be required if employer does not sign form.
Customer Signature
Date
Return form to employee or the Department of Workforce Services:
Mail - Department of Workforce Services, Imaging Operations, P.O. Box 143245, Salt Lake City, UT 84114-3245
Fax - Salt Lake City Area: 801-526-9500 or Toll free: 1-877-313-4717
Equal Opportunity Employer/Program
Auxiliary aids and services are available upon request to individuals with disabilities by calling 801-526-9240. Individuals
who are deaf, hard of hearing, or have speech impairments may call Relay Utah by dialing 711. Spanish Relay Utah: 1-888-346-3162.
DWS-ESD 630
State of Utah
Rev. 04/2020
Department of Workforce Services
EMPLOYMENT INFORMATION
Case name:
Case number:
Employed person:
SSN:
For new, changes, and returning employment, the entire form must be completed
D11120900160101
and signed by the employer. Please use a black pen to complete form.
Employer Information:
Company name:
Corporate name (if different):
Payroll company (if different):
Company address:
Name of supervisor or HR contact:
Phone number:
Employee Information:
1. Date employment began, changed, or returned to work after leave of absence:
2. Is the employment temporary?
Yes
No If yes, what is the expected end date?
3. Is the employment considered Educational Work Study?
Yes
No
4. Hourly wage: $
/hr. or Salary: $
/Monthly
/Yearly
5. Will the number of hours worked each week vary?
Yes
No
If yes, minimum hours:
Maximum hours:
If no, list the number of hours worked each week:
6. Are there months where this employee works more or less than the hours reported in question 5?
Yes
No If yes, which months and how many
(e.g., a teacher who does not work during the summer)
hours will the employee work each week?
7. Is overtime offered on a regular basis?
Yes
No
Weekly overtime hours:
Overtime rate: $
8. How often paid?:
Every two weeks
List day of the week paid:
(e.g., every other Friday)
Twice per month
List dates:
(e.g., 5th and 20th)
Weekly
Monthly
Other:
9. Date first paycheck will be (or was) received:
What is the estimated gross amount
? $
Hours paid on the first check?
(before taxes)
10. When does the pay period end
?
(e.g., every other Friday or 15th and 30th)
11. Does employment include tips, commission, health savings account or shift differential?
Yes
No
If yes, list amount and frequency:
12. Does employment include bonuses
?
Yes
No
(e.g., holiday, profit-sharing, performance, etc.)
If yes, list amount and frequency:
13. Does the employer offer health insurance?
Yes
No
Is the employee eligible to enroll?
Yes
No
If no why:
14. If terminated, list the termination date:
Date of final pay check:
Employer Signature*
Date
*Additional verification will be required if employer does not sign form.
Customer Signature
Date
Return form to employee or the Department of Workforce Services:
Mail - Department of Workforce Services, Imaging Operations, P.O. Box 143245, Salt Lake City, UT 84114-3245
Fax - Salt Lake City Area: 801-526-9500 or Toll free: 1-877-313-4717
Equal Opportunity Employer/Program
Auxiliary aids and services are available upon request to individuals with disabilities by calling 801-526-9240. Individuals
who are deaf, hard of hearing, or have speech impairments may call Relay Utah by dialing 711. Spanish Relay Utah: 1-888-346-3162.