Employer Information

Federal Identification No.:
Employer UI Acct No.:

VIRGIN ISLANDS DEPARTMENT OF LABOR

NEW HIRE REPORTING FORM

Return To:      NEW HIRE PROGRAM                  
Employer Name:
Physical Address:
  PO BOX 303359
ST. THOMAS, VI 00803-3359
Mailing Address:
 

Tel: (340)776-3700 ext. 2046
Fax: (340)777-4803
E-mail: lespringette@vidol.gov

Telephone No.:
EMPLOYEE INFORMATION
Social Security Number

Employee Name

First - MI - Last

 Physical Address City State Zip Code

Date of

Birth

(mm/dd/yy)

Date of

Hire

(mm/dd/yy)

State

of Hire
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.