State of Illinois 
Department of  Employment Security

New Hire Reporting Form

Employers must report each new hire within 20 days.   Assistance: 1 800 327-HIRE (4473) 
                                  Please print or type

                                  EMPLOYER NAME AND ADDRESS

Federal Employer ID Number - FEIN  -

Company Name

Street Address

Street Address

City                              State             Zip Code                            -

                  EMPLOYER ADDRESS FOR CHILD SUPPORT WAGE WITHHOLDING ORDERS

Street Address

Street Address

City                              State               Zip Code                          -

                                  NEW EMPLOYEE NAME AND ADDRESS

Social Security Number                              Date of Hire (MM-DD-YYYY)         -                       - 

First Name                              MI          Last Name

Street Address

City                              State             Zip Code                            -

                                  NEW EMPLOYEE NAME AND ADDRESS

Social Security Number                              Date of Hire (MM-DD-YYYY)         -                       - 

First Name                              MI          Last Name

Street Address

City                              State             Zip Code                            -

                  Report new hires online, or by returning your completed form either by FAX 1-217-557-1947,  
                  or by U.S. mail to IDES, P.O. Box 19473, Springfield, IL 62794-9473.