Oklahoma New Hire Reporting Form OES-112(11-11)
Please fill out completely and mail to: Oklahoma New Hire Reporting Center Download a copy of this form at: www.ok.gov/oesc/index.php?c=11
PO Box 52003
Oklahoma City OK 73152-2003 OKDHS - Oklahoma Employer Services Center Information Number:
OR FAX to: 1-800-317-3786 or OKC Metro Area (405) 557-5350 1-866-553-2368 or OKC Metro Area (405) 325-9190
Federal Employer Identification Number Oklahoma Account Number
- -
Company Name Payroll Processing Area Code, Phone Number Extension
Payroll Processing Address Line 1 City State
Payroll Processing Address Line 2 Country
Payroll Processing Address Line 3 ZIP Code
Social Security Number Occupation
_ _
First Name Middle 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 Day Year
State ZIP Code Dependent health insurance available?
-
Yes No
Date of Birth Is this person currently employed with your company?
Month Day Year
Yes No
Employer Information
New or Rehired Employee Information
Fillable Form - Type your information and print for submission
