NEW MEXICO NEW HIRE REPORTING FORM 
                                                           
Send completed forms to:                                                   Fax forms toll free: 1-888-878-1614 
New Mexico New Hires Directory                                         Submit Online: www.nm-newhire.com 
PO Box 29480                                                          For more information: 1-888-878-1607 
Santa Fe, NM 87592-9480 
 
                                   COMPANY INFORMATION 
                                    *Required Information 

Federal Employer Identification Number* _____________________________________________________________ 
Company Name* _________________________________________________________________________________ 
Payroll Address* _________________________________________________________________________________ 
(Address where Income Withholding Orders should be sent) 
City, State, Zip Code* _____________________________________________________________________________ 
Contact Name/Phone ______________________________________________________________________________ 
Contact/Company Email ___________________________________________________________________________ 
 
                                   EMPLOYEE INFORMATION 
                                    *Required Information 

Employee #1 
Name* _______________________________________________________   Date of Hire* ________________  
Social Security Number*_________________________________________   Date of Birth _________________ 
Address* _____________________________________________________    State of Hire _________________ 
City, State, Zip Code* ___________________________________________   Medical Insurance Available? 
                                                                       YES   NO 
Employee #2 
Name* _______________________________________________________   Date of Hire* ________________  
Social Security Number*_________________________________________   Date of Birth _________________ 
Address* _____________________________________________________    State of Hire _________________ 
City, State, Zip Code* ___________________________________________   Medical Insurance Available? 
                                                                       YES   NO 
Employee #3 
Name* _______________________________________________________   Date of Hire* ________________  
Social Security Number*_________________________________________   Date of Birth _________________ 
Address* _____________________________________________________    State of Hire _________________ 
City, State, Zip Code* ___________________________________________   Medical Insurance Available? 
                                                                       YES   NO