SD Eform - 0778 V1 -- Complete and use the button at the end to print for mailing

South Dakota New Hire Reporting Form

Date: * Employer
FEIN: * Employer Name: * Employer Address: *

City t

State *

Zip: *

Contact: *

Telephone *--

Employee SSN:

First Name:

Middle Name:

Last Name: Employee Address:

City t

State

Zip:

Hire Date:

Employee SSN:

First Name:

Middle Name:

Last Name: Employee Address:

City t

State

Zip:

Hire Date:

Employee SSN:

First Name:

Middle Name:

Last Name: Employee Address:

City t

State

Zip:

Hire Date:

Mailing Address:
New Hire Reporting Center
SD Department of Labor and Regulation
P.O. Box 4700
Aberdeen, SD 57402-4700

Fax:
1-888-835-8659 (Toll Free)
1-605-626-2842 (Local)
Phone:
1-888-827-6078 (Toll Free)
1-605-626-2942 (Local)