State Of New Jersey New Hire Reporting Form
This form is for employers to report employee information with the New Jersey Division of Revenue. The form provided here is simply a sample of what the actual form looks like.
STATE OF NEW JERSEY
DIVISION OF REVENUE
Please mail to:
New Jersey New Hire Operations Center
PO Box 4654
Trenton, NJ 08650-4654
TO ENSURE ACCURACY, PLEASE PRINT (OR TYPE) NEATLY IN UPPER-CASE LETTERS AND NUMBERS, USING A DARK, BALL POINT PEN
STATE OF NEW JERSEY NEW HIRE REPORTING FORM
EMPLOYER FEDERAL EIN ________________________
EMPLOYER INFORMATION:
Employer Name ________________________ (name, d/b/a, etc.)
Employer Payroll Address
________________________
________________________
Employer Payroll City ________________________
State ________________________
Zip Code + 4 (optional) ________________________
EMPLOYEE INFORMATION:
Employee Social Security Number ________________________
First Name ________________________
Last Name ________________________
MI (opt.) ________________________
Employee Address ________________________
City ________________________
State ________________________
Zip Code + 4 (optional) ________________________
Date of Hire (optional) ________________________
Date of Birth (if available) ________________________
Gender (optional) ____ Male ____ Female
THIS FORM MAY BE REPRODUCED