Fillable Reports must be submitted within 20 days of

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Rev. 11/2019
Reports must be submitted within 20 days of date of hire or rehire.
REPORTS WILL NOT BE PROCESSED IF REQUIRED INFORMATION IS MISSING.
For additional information, call (888) 514-4568 or visit us online at www.ncnewhires.com.
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Completed 11 February 2021

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