|NOTE: Title 16, Chapter
13, Subchapter I, Section 378(g), Virgin Islands Code and 42 U.S.C. 653A(B)(1)(B)
PERSONAL RESPOVSIBILITY AND WORK OPPORTUNITY ACT OF 1996 (PUBLIC LAW
104-193) requires all employers to report all new employees within
Twenty (20) Days of the date of hire. The date of hire is the first day
the individual performs services for you. If additional space is needed,
copy this form and submit additional names.