Oklahoma New Hire Reporting Form                                           OES-112  (rev. 05-24)

Please fill out completely and mail to:   Oklahoma New Hire Reporting Center            OKDHS - Oklahoma Employer Services Center Information Number: 
                                          PO Box 52003                                  1-866-553-2368  or  OKC Metro Area (405) 325-9190
                                          Oklahoma City   OK  73152-2003
               OR FAX to:                 (405) 557-5350

Fillable Form - Type your information and print for submission               Employer Information                                          RESET

Federal Employer Identification Number                                           Oklahoma Account Number
       -                                                                                           -
Company Name                                                                             Payroll Processing   Area Code,    Phone Number                Extension

Payroll Processing Address Line 1                                                City                                                                 State

Payroll Processing Address Line 2                                                Country

Payroll Processing Address Line 3                                                ZIP Code

                                                                  New or Rehired Employee Information

Social Security Number                                                             Occupation
                _                        _

First Name             Middle                                  Last Name           Starting Salary
                                                                                 $                             Hour           Week      Commission / Other
                                                                                                               Month          Year

Mailing Address
                                                                                 „  New Hire               „  Recalled                   State of Hire

City                                                                               Date Started to Work or Recalled
                                                                                                  Month                   Day              Year

State                                                   ZIP  Code                  Dependent health insurance available?
                                                        -                         ‚  Yes                ‚  No

Date of Birth                                                                        Is this person currently employed with your company?
Month                  Day                              Year
                                                                                     Yes                No