Employer New Hire Form

As part of our agreement with employers, we request information from your company/organization when you hire an individual. ETR requires accurate up-to-date information in order to continue to provide our services at no cost to you and others.  Thank you for your cooperation.

To whom at ETR would you like this information sent?

To whom at ETR would you like this information sent?

If Other, who would you like this information sent to?

Company Information

Company Name

Contact Name

Telephone (including extension)

E-mail Address

Who Did You Hire?

New Employee Name

Last 4 digits of SSN

Job Information

Job Order Number (if applicable)

Job Start Date

Job Title

Pay Per   Plus Commission   Plus Tips

Hours Per Week

Is This a Permanent Position? Yes  No     If Temporary, for how long?

Benefits:  (Please check all that apply)

 Medical Insurance    Pension Plan/Social Security    No Benefits

Is this job an Apprenticeship position?   Yes  No

Is this job a Union position?  Yes  No

If this is a union position, was it filled through a Union Hall?  Yes  No


Thank you for taking the time to share this important information with us.

To complete the form:



If you experience problems with this form, please contact your local Business Services Representative for assistance.