"New Hire Report Form" - Maine

New Hire Report Form is a legal document that was released by the Maine Department of Labor - a government authority operating within Maine.

Form Details:

  • Released on September 1, 2009;
  • The latest edition currently provided by the Maine Department of Labor;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Maine Department of Labor.

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New Hire Reporting Program-Report Form
If you use this form to report, please make and keep extra copies for future
reporting.
Employer name and address:
DOL State Id:
Federal Id:
Employee Information
Independent Contractor Information
Information
SSN:
1.
Name:
Address:
City:
Zip:
State:
Date
of
Date of Hire:
termination:
Birth Date:
Home Phone:
Work Phone:
Occupation:
Income freq:
(Weekly, Bi-Weekly, Monthly)
Gross Income Amt:
Ins. Avail for Employee
(YIN):
CostIAmt:
Dep Covered
Ins. Avail for Dependent
(YIN):
Date of contract
Date payments exceeded $2,500
Date Contracts end
Total amount of Contract
Information
SSN:
1.
Name:
Address:
City:
Zip:
State:
Date
of
Date of Hire:
termination:
Birth Date:
Home Phone:
Work Phone:
Occupation:
Income freq:
(Weekly, Bi-Weekly, Monthly)
Gross Income Amt:
Ins. Avail for Employee
(YIN):
CostIAmt:
Dep Covered
Ins. Avail for Dependent
(YIN):
Date of contract
Date payments exceeded $2,500
Date Contracts end
Total amount of Contract
Mail to:
DSER-New Hire Reporting Program
or FAX to:
(207) 287-6882
State House Station
11
(800) 437-9611
Augusta, ME
04333-0011
R0909
New Hire Reporting Program-Report Form
If you use this form to report, please make and keep extra copies for future
reporting.
Employer name and address:
DOL State Id:
Federal Id:
Employee Information
Independent Contractor Information
Information
SSN:
1.
Name:
Address:
City:
Zip:
State:
Date
of
Date of Hire:
termination:
Birth Date:
Home Phone:
Work Phone:
Occupation:
Income freq:
(Weekly, Bi-Weekly, Monthly)
Gross Income Amt:
Ins. Avail for Employee
(YIN):
CostIAmt:
Dep Covered
Ins. Avail for Dependent
(YIN):
Date of contract
Date payments exceeded $2,500
Date Contracts end
Total amount of Contract
Information
SSN:
1.
Name:
Address:
City:
Zip:
State:
Date
of
Date of Hire:
termination:
Birth Date:
Home Phone:
Work Phone:
Occupation:
Income freq:
(Weekly, Bi-Weekly, Monthly)
Gross Income Amt:
Ins. Avail for Employee
(YIN):
CostIAmt:
Dep Covered
Ins. Avail for Dependent
(YIN):
Date of contract
Date payments exceeded $2,500
Date Contracts end
Total amount of Contract
Mail to:
DSER-New Hire Reporting Program
or FAX to:
(207) 287-6882
State House Station
11
(800) 437-9611
Augusta, ME
04333-0011
R0909