Oklahoma New Hire Reporting Form                                                                        OES-112(11-11)

Please fill out completely and mail to:   Oklahoma New Hire Reporting Center                                                                 Download a copy of this form at:     www.ok.gov/oesc/index.php?c=11
                                                               PO Box 52003                                                                      
                                          Oklahoma City   OK  73152-2003                                                                         OKDHS - Oklahoma Employer Services Center Information Number:
               OR FAX to:                 1-800-317-3786   or   OKC Metro Area (405) 557-5350                                     1-866-553-2368  or  OKC Metro Area (405) 325-9190

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