ATE OF IRTH
 D B            NHES 0085 R-12/15 
 
  MPLOYEE  “I” 
E IRE  OR 
     YPE OF H
 FORM                                  T “W”            
 
  ” for W-2 ORK TA TE
W W S            
ONTRACTOR
  C
ROGRAM  
P
 REPORTING  :1-855-253-9072 IRST AY OF ORK
IRE  03302-2092 *F D W
H AX              
NH  224-0825 F NDEPENDENT I                                                                                           
 HIRE EW 2092 IP
OX 
 -N REE *Z            
 B  :(603) F      
1099  
For “Type of Hire” write “  
NEW ONCORD AX OLL : 
 :NHES PO  C F T ” forI TATE
O *S            
T Note or “
               *Required Fields
                                                       
ETURN 
 R                                   OWN
 /T
                      
                                                                                                                                                                                                                                                                                                           ITY
   *C
             
DDRESS  
  A  
 
  OME (NOT PO BOX) 
  *H
 )_________________________            
 :___________________________  
 :______________________________ N            (:  :_____________________________
O   
 )_______________________________
O O  
N  N ERSON 
CCOUNT  :____________________________________             ( P  AME
:
A  _______________________________________ O N
:  N  
 
ELEPHONE AX ONTACT  
AME DDRESS T F C
DENTIFICATION I N A             
MPLOYER  MPLOYEE 
 E
                      *E Online “New Hire” filing link can be found on homepage http://www.nhes.nh.gov/ 
Note: All new hires must be reported within 20 days of the date hired. ** Independent contractors are reportable if contractor operates business as a sole proprietor and you expect to reimburse  individual more than $2,500 for services for one or more contracts in a calendar year. (EMP308.02(a)(3)).  Indicate contractor’s name, home or business address, social security number and first day of work.  
EDERAL MPLOYER MPLOYER MPLOYER MPLOYER MPLOYER **(or Independent Contractor) 
F  NHES                                                                                                                                                                                    E  E _____________________________________________________ E E E
                     
# 
- - - - - - - - - - - 
                   
 OCIAL                         -             -             -             -             -             -             -             -             -             -
-
*S ECURITY 
                                                                                                                                                                                                                                                                                                                            S