Form LOC20 "Maine New Hire Reporting Form" - Maine

What Is Form LOC20?

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

Form Details:

  • Released on September 1, 2013;
  • The latest edition provided by the Maine Department of Health and Human 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 LOC20 by clicking the link below or browse more documents and templates provided by the Maine Department of Health and Human Services.

ADVERTISEMENT
ADVERTISEMENT

Download Form LOC20 "Maine New Hire Reporting Form" - Maine

Download PDF

Fill PDF online

Rate (4.3 / 5) 89 votes
Maine New Hire Reporting Form
DOL State ID: _________________________
Employer Name and Address:
Federal ID: _________________________
Employee Information:
1. SSN: ________________________ Employee Name: ________________________________________
Employee Address: ____________________________________________________________________
City: __________________________________ State: ___________________ Zip: ________________
Date of Birth: ________________ Date of Hire: ______________ Date of Termination: ______________
Home Phone: _____________________________ Work Phone:
_______________________________
Re-Hire: Y /
N
Occupation: _________________________________________________________
Pay Frequency: HR / WK / MO / YR
Gross Amount: $__________________________________
Insurance Available for Employee? Y / N
Cost: $__________ Employee Covered? Y / N
Insurance Available for Dependent(s)? Y / N Cost: $__________ Dependent covered? Y / N
2. SSN: ________________________ Employee Name: ________________________________________
Employee Address: ____________________________________________________________________
City: __________________________________ State: ___________________ Zip: ________________
Date of Birth: ________________ Date of Hire: ______________ Date of Termination: ______________
Home Phone: _____________________________ Work Phone:
_______________________________
Re-Hire: Y /
N
Occupation: _________________________________________________________
Pay Frequency: HR / WK / MO / YR
Gross Amount: $__________________________________
Insurance Available for Employee? Y / N
Cost: $__________ Employee Covered? Y / N
Insurance Available for Dependent(s)? Y / N Cost: $__________ Dependent covered? Y / N
3. SSN: ________________________ Employee Name: ________________________________________
Employee Address: ____________________________________________________________________
City: __________________________________ State: ___________________ Zip: ________________
Date of Birth: ________________ Date of Hire: ______________ Date of Termination: ______________
Home Phone: _____________________________ Work Phone:
_______________________________
Re-Hire: Y /
N
Occupation: _________________________________________________________
Pay Frequency: HR / WK / MO / YR
Gross Amount: $__________________________________
Insurance Available for Employee? Y / N
Cost: $__________ Employee Covered? Y / N
Insurance Available for Dependent(s)? Y / N Cost: $__________ Dependent covered? Y / N
Mail to: DSER – New Hire Reporting Program
Or Fax to: (207) 287-6882
11 State House Station
(800) 437-9611
Augusta, ME 04330-0011
LOC20 R092013
Maine New Hire Reporting Form
DOL State ID: _________________________
Employer Name and Address:
Federal ID: _________________________
Employee Information:
1. SSN: ________________________ Employee Name: ________________________________________
Employee Address: ____________________________________________________________________
City: __________________________________ State: ___________________ Zip: ________________
Date of Birth: ________________ Date of Hire: ______________ Date of Termination: ______________
Home Phone: _____________________________ Work Phone:
_______________________________
Re-Hire: Y /
N
Occupation: _________________________________________________________
Pay Frequency: HR / WK / MO / YR
Gross Amount: $__________________________________
Insurance Available for Employee? Y / N
Cost: $__________ Employee Covered? Y / N
Insurance Available for Dependent(s)? Y / N Cost: $__________ Dependent covered? Y / N
2. SSN: ________________________ Employee Name: ________________________________________
Employee Address: ____________________________________________________________________
City: __________________________________ State: ___________________ Zip: ________________
Date of Birth: ________________ Date of Hire: ______________ Date of Termination: ______________
Home Phone: _____________________________ Work Phone:
_______________________________
Re-Hire: Y /
N
Occupation: _________________________________________________________
Pay Frequency: HR / WK / MO / YR
Gross Amount: $__________________________________
Insurance Available for Employee? Y / N
Cost: $__________ Employee Covered? Y / N
Insurance Available for Dependent(s)? Y / N Cost: $__________ Dependent covered? Y / N
3. SSN: ________________________ Employee Name: ________________________________________
Employee Address: ____________________________________________________________________
City: __________________________________ State: ___________________ Zip: ________________
Date of Birth: ________________ Date of Hire: ______________ Date of Termination: ______________
Home Phone: _____________________________ Work Phone:
_______________________________
Re-Hire: Y /
N
Occupation: _________________________________________________________
Pay Frequency: HR / WK / MO / YR
Gross Amount: $__________________________________
Insurance Available for Employee? Y / N
Cost: $__________ Employee Covered? Y / N
Insurance Available for Dependent(s)? Y / N Cost: $__________ Dependent covered? Y / N
Mail to: DSER – New Hire Reporting Program
Or Fax to: (207) 287-6882
11 State House Station
(800) 437-9611
Augusta, ME 04330-0011
LOC20 R092013