Fillable Out of State Employee Report (Montana State University - Billings)

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Out of State Employee Report (Montana State University - Billings)

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Out of State Employee Report
Departments must report any employees working outside of Montana to Human Resources and the Payroll
Office. This is required for adequate workers compensation coverage of the employee and compliance with
state and federal statutes.
Employee Name:_______________________________ Employee ID:_______________
Address of employee’s work site out of state:
Street______________________________________________
City, State, Zip_______________________________________
Is this employee a resident of Montana? _________________
Is this employee a non-resident alien?___________________
Is this employee working out of state temporarily or
permanently?__________________________________
If temporarily out of state, how long? ________________________
Describe the nature of the work being done out of state
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Additional Comments:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Department:_______________________Submitted by:______________________Date:___________
Submit form along with hiring paperwork to Human Resources Office
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Out of State Employee Report (Montana State University - Billings)

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Completed 23 July 2020

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