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 
                                   (Print or Type) 

Federal Employer  
Identification Number*   _____________________________________________________________________ 

Company Name*             _____________________________________________________________________ 

Street Address*               _____________________________________________________________________ 

City, State, Zip Code*    _____________________________________________________________________ 

Contact Name/Phone            _____________________________________________________________________ 

Contact/Company Email _____________________________________________________________________ 

Payroll Address 
(if different from above)     _____________________________________________________________________ 

City, State, Zip Code         _____________________________________________________________________ 

                                  EMPLOYEE INFORMATION 

Employee #1 

Name*                       ___________________________________________    Date of Birth _________________

Social Security Number*___________________________________________    Date of Hire*_________________

Address*                         ___________________________________________    State of Hire  _________________

City, State, Zip Code*   ___________________________________________    Medical Insurance     YES 
                                                                                                                                       Available?             NO  

Employee #2 

Name*                       ___________________________________________    Date of Birth _________________

Social Security Number*___________________________________________    Date of Hire*_________________

Address*                         ___________________________________________    State of Hire  _________________

City, State, Zip Code*   ___________________________________________    Medical Insurance     YES 
                                                                                                                                       Available?             NO  

*Required Information