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
---
Aberdeen
Agar
Akaska
Albee
Alcester
Alexandria
Allen
Alpena
Altamont
Andover
Antelope
Arlington
Armour
Artas
Artesian
Ashland Heights
Ashton
Astoria
Aurora
Aurora Center
Avon
Badger
Baltic
Bancroft
Batesland
Belle Fourche
Belvidere
Beresford
Big Stone City
Bison
Blackhawk
Blunt
Bonesteel
Bowdle
Box Elder
Bradley
Brandon
Brandt
Brentford
Bridgewater
Bristol
Britton
Broadland
Brookings
Bruce
Bryant
Buffalo
Buffalo Gap
Bullhead
Burke
Bushnell
Butler
Camp Crook
Canistota
Canova
Canton
Carthage
Castlewood
Cavour
Centerville
Central City
Chamberlain
Chancellor
Chelsea
Claire City
Claremont
Clark
Clear Lake
Colman
Colome
Colonial Pine Hills
Colton
Columbia
Conde
Corona
Corsica
Cottonwood
Cresbard
Crooks
Custer
Dallas
Dante
Davis
Deadwood
Dell Rapids
Delmont
De Smet
Dimock
Doland
Dolton
Draper
Dupree
Eagle Butte
Eden
Edgemont
Egan
Elk Point
Elkton
Ellsworth AFB
Emery
Erwin
Estelline
Ethan
Eureka
Fairburn
Fairfax
Fairview
Faith
Farmer
Faulkton
Flandreau
Florence
Fort Pierre
Fort Thompson
Frankfort
Frederick
Freeman
Fruitdale
Fulton
Garden City
Garretson
Gary
Gayville
Geddes
Gettysburg
Glenham
Goodwin
Green Grass
Green Valley
Gregory
Grenville
Groton
Hamill
Harrisburg
Harrison
Harrold
Hartford
Hayti
Hazel
Hecla
Henry
Hermosa
Herreid
Herrick
Hetland
Highmore
Hill City
Hillsview
Hitchcock
Hosmer
Hot Springs
Hoven
Howard
Hudson
Humboldt
Hurley
Huron
Interior
Ipswich
Irene
Iroquois
Isabel
Java
Jefferson
Kadoka
Kaylor
Kennebec
Keystone
Kimball
Kranzburg
Kyle
La Bolt
Lake Andes
Lake City
Lake Norden
Lake Preston
Lane
Langford
La Plant
Lead
Lebanon
Lemmon
Lennox
Leola
Lesterville
Letcher
Lily
Little Eagle
Long Lake
Loomis
Lower Brule
Lowry
McIntosh
McLaughlin
Madison
Manderson-White Horse Creek
Marion
Martin
Marty
Marvin
Mellette
Menno
Midland
Milbank
Miller
Milltown
Mission
Mission Hill
Mitchell
Mobridge
Monroe
Montrose
Morristown
Mound City
Mount Vernon
Murdo
Naples
New Effington
Newell
New Holland
New Underwood
New Witten
Nisland
North Eagle Butte
North Sioux City
North Spearfish
Northville
Nunda
Oacoma
Oglala
Okaton
Oldham
Olivet
Onaka
Onida
Orient
Ortley
Parker
Parkston
Parmelee
Peever
Philip
Pickstown
Pierpont
Pierre
Pine Ridge
Plankinton
Platte
Pollock
Porcupine
Presho
Pringle
Pukwana
Quinn
Ramona
Rapid City
Rapid Valley
Ravinia
Raymond
Redfield
Ree Heights
Reliance
Revillo
Rockham
Roscoe
Rosebud
Rosholt
Roslyn
Roswell
St. Charles
St. Francis
St. Lawrence
Salem
Scotland
Selby
Seneca
Sherman
Sinai
Sioux Falls
Sisseton
South Shore
Spearfish
Spencer
Spring Creek
Springfield
Stickney
Stockholm
Storla
Strandburg
Stratford
Sturgis
Summit
Tabor
Tea
Timber Lake
Tolstoy
Toronto
Trent
Tripp
Tulare
Turton
Twin Brooks
Two Strike
Tyndall
Utica
Valley Springs
Veblen
Verdon
Vermillion
Viborg
Vienna
Vilas
Virgil
Vivian
Volga
Volin
Wagner
Wakonda
Wall
Wallace
Wanblee
Ward
Warner
Wasta
Watertown
Waubay
Webster
Wentworth village
Wessington
Wessington Springs
Westport
Wetonka
White
Whitehorse
White Horse
White Lake
White River
White Rock
Whitewood
Willow Lake
Wilmot
Winner
Wolsey
Wood
Woonsocke
t
Worthing
Wounded Knee
Yale
Yankton
Zell
Zeona
State
*
---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Marianas Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virgin Islands
Washington
West Virginia
Wisconsin
Wyoming
Zip:
*
Contact:
*
Telephone
*
-
-
Employee SSN:
First Name:
Middle Name:
Last Name:
Employee Address:
City
---
Aberdeen
Agar
Akaska
Albee
Alcester
Alexandria
Allen
Alpena
Altamont
Andover
Antelope
Arlington
Armour
Artas
Artesian
Ashland Heights
Ashton
Astoria
Aurora
Aurora Center
Avon
Badger
Baltic
Bancroft
Batesland
Belle Fourche
Belvidere
Beresford
Big Stone City
Bison
Blackhawk
Blunt
Bonesteel
Bowdle
Box Elder
Bradley
Brandon
Brandt
Brentford
Bridgewater
Bristol
Britton
Broadland
Brookings
Bruce
Bryant
Buffalo
Buffalo Gap
Bullhead
Burke
Bushnell
Butler
Camp Crook
Canistota
Canova
Canton
Carthage
Castlewood
Cavour
Centerville
Central City
Chamberlain
Chancellor
Chelsea
Claire City
Claremont
Clark
Clear Lake
Colman
Colome
Colonial Pine Hills
Colton
Columbia
Conde
Corona
Corsica
Cottonwood
Cresbard
Crooks
Custer
Dallas
Dante
Davis
Deadwood
Dell Rapids
Delmont
De Smet
Dimock
Doland
Dolton
Draper
Dupree
Eagle Butte
Eden
Edgemont
Egan
Elk Point
Elkton
Ellsworth AFB
Emery
Erwin
Estelline
Ethan
Eureka
Fairburn
Fairfax
Fairview
Faith
Farmer
Faulkton
Flandreau
Florence
Fort Pierre
Fort Thompson
Frankfort
Frederick
Freeman
Fruitdale
Fulton
Garden City
Garretson
Gary
Gayville
Geddes
Gettysburg
Glenham
Goodwin
Green Grass
Green Valley
Gregory
Grenville
Groton
Hamill
Harrisburg
Harrison
Harrold
Hartford
Hayti
Hazel
Hecla
Henry
Hermosa
Herreid
Herrick
Hetland
Highmore
Hill City
Hillsview
Hitchcock
Hosmer
Hot Springs
Hoven
Howard
Hudson
Humboldt
Hurley
Huron
Interior
Ipswich
Irene
Iroquois
Isabel
Java
Jefferson
Kadoka
Kaylor
Kennebec
Keystone
Kimball
Kranzburg
Kyle
La Bolt
Lake Andes
Lake City
Lake Norden
Lake Preston
Lane
Langford
La Plant
Lead
Lebanon
Lemmon
Lennox
Leola
Lesterville
Letcher
Lily
Little Eagle
Long Lake
Loomis
Lower Brule
Lowry
McIntosh
McLaughlin
Madison
Manderson-White Horse Creek
Marion
Martin
Marty
Marvin
Mellette
Menno
Midland
Milbank
Miller
Milltown
Mission
Mission Hill
Mitchell
Mobridge
Monroe
Montrose
Morristown
Mound City
Mount Vernon
Murdo
Naples
New Effington
Newell
New Holland
New Underwood
New Witten
Nisland
North Eagle Butte
North Sioux City
North Spearfish
Northville
Nunda
Oacoma
Oglala
Okaton
Oldham
Olivet
Onaka
Onida
Orient
Ortley
Parker
Parkston
Parmelee
Peever
Philip
Pickstown
Pierpont
Pierre
Pine Ridge
Plankinton
Platte
Pollock
Porcupine
Presho
Pringle
Pukwana
Quinn
Ramona
Rapid City
Rapid Valley
Ravinia
Raymond
Redfield
Ree Heights
Reliance
Revillo
Rockham
Roscoe
Rosebud
Rosholt
Roslyn
Roswell
St. Charles
St. Francis
St. Lawrence
Salem
Scotland
Selby
Seneca
Sherman
Sinai
Sioux Falls
Sisseton
South Shore
Spearfish
Spencer
Spring Creek
Springfield
Stickney
Stockholm
Storla
Strandburg
Stratford
Sturgis
Summit
Tabor
Tea
Timber Lake
Tolstoy
Toronto
Trent
Tripp
Tulare
Turton
Twin Brooks
Two Strike
Tyndall
Utica
Valley Springs
Veblen
Verdon
Vermillion
Viborg
Vienna
Vilas
Virgil
Vivian
Volga
Volin
Wagner
Wakonda
Wall
Wallace
Wanblee
Ward
Warner
Wasta
Watertown
Waubay
Webster
Wentworth village
Wessington
Wessington Springs
Westport
Wetonka
White
Whitehorse
White Horse
White Lake
White River
White Rock
Whitewood
Willow Lake
Wilmot
Winner
Wolsey
Wood
Woonsocke
t
Worthing
Wounded Knee
Yale
Yankton
Zell
Zeona
State
---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Marianas Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virgin Islands
Washington
West Virginia
Wisconsin
Wyoming
Zip:
Hire Date:
Employee SSN:
First Name:
Middle Name:
Last Name:
Employee Address:
City
---
Aberdeen
Agar
Akaska
Albee
Alcester
Alexandria
Allen
Alpena
Altamont
Andover
Antelope
Arlington
Armour
Artas
Artesian
Ashland Heights
Ashton
Astoria
Aurora
Aurora Center
Avon
Badger
Baltic
Bancroft
Batesland
Belle Fourche
Belvidere
Beresford
Big Stone City
Bison
Blackhawk
Blunt
Bonesteel
Bowdle
Box Elder
Bradley
Brandon
Brandt
Brentford
Bridgewater
Bristol
Britton
Broadland
Brookings
Bruce
Bryant
Buffalo
Buffalo Gap
Bullhead
Burke
Bushnell
Butler
Camp Crook
Canistota
Canova
Canton
Carthage
Castlewood
Cavour
Centerville
Central City
Chamberlain
Chancellor
Chelsea
Claire City
Claremont
Clark
Clear Lake
Colman
Colome
Colonial Pine Hills
Colton
Columbia
Conde
Corona
Corsica
Cottonwood
Cresbard
Crooks
Custer
Dallas
Dante
Davis
Deadwood
Dell Rapids
Delmont
De Smet
Dimock
Doland
Dolton
Draper
Dupree
Eagle Butte
Eden
Edgemont
Egan
Elk Point
Elkton
Ellsworth AFB
Emery
Erwin
Estelline
Ethan
Eureka
Fairburn
Fairfax
Fairview
Faith
Farmer
Faulkton
Flandreau
Florence
Fort Pierre
Fort Thompson
Frankfort
Frederick
Freeman
Fruitdale
Fulton
Garden City
Garretson
Gary
Gayville
Geddes
Gettysburg
Glenham
Goodwin
Green Grass
Green Valley
Gregory
Grenville
Groton
Hamill
Harrisburg
Harrison
Harrold
Hartford
Hayti
Hazel
Hecla
Henry
Hermosa
Herreid
Herrick
Hetland
Highmore
Hill City
Hillsview
Hitchcock
Hosmer
Hot Springs
Hoven
Howard
Hudson
Humboldt
Hurley
Huron
Interior
Ipswich
Irene
Iroquois
Isabel
Java
Jefferson
Kadoka
Kaylor
Kennebec
Keystone
Kimball
Kranzburg
Kyle
La Bolt
Lake Andes
Lake City
Lake Norden
Lake Preston
Lane
Langford
La Plant
Lead
Lebanon
Lemmon
Lennox
Leola
Lesterville
Letcher
Lily
Little Eagle
Long Lake
Loomis
Lower Brule
Lowry
McIntosh
McLaughlin
Madison
Manderson-White Horse Creek
Marion
Martin
Marty
Marvin
Mellette
Menno
Midland
Milbank
Miller
Milltown
Mission
Mission Hill
Mitchell
Mobridge
Monroe
Montrose
Morristown
Mound City
Mount Vernon
Murdo
Naples
New Effington
Newell
New Holland
New Underwood
New Witten
Nisland
North Eagle Butte
North Sioux City
North Spearfish
Northville
Nunda
Oacoma
Oglala
Okaton
Oldham
Olivet
Onaka
Onida
Orient
Ortley
Parker
Parkston
Parmelee
Peever
Philip
Pickstown
Pierpont
Pierre
Pine Ridge
Plankinton
Platte
Pollock
Porcupine
Presho
Pringle
Pukwana
Quinn
Ramona
Rapid City
Rapid Valley
Ravinia
Raymond
Redfield
Ree Heights
Reliance
Revillo
Rockham
Roscoe
Rosebud
Rosholt
Roslyn
Roswell
St. Charles
St. Francis
St. Lawrence
Salem
Scotland
Selby
Seneca
Sherman
Sinai
Sioux Falls
Sisseton
South Shore
Spearfish
Spencer
Spring Creek
Springfield
Stickney
Stockholm
Storla
Strandburg
Stratford
Sturgis
Summit
Tabor
Tea
Timber Lake
Tolstoy
Toronto
Trent
Tripp
Tulare
Turton
Twin Brooks
Two Strike
Tyndall
Utica
Valley Springs
Veblen
Verdon
Vermillion
Viborg
Vienna
Vilas
Virgil
Vivian
Volga
Volin
Wagner
Wakonda
Wall
Wallace
Wanblee
Ward
Warner
Wasta
Watertown
Waubay
Webster
Wentworth village
Wessington
Wessington Springs
Westport
Wetonka
White
Whitehorse
White Horse
White Lake
White River
White Rock
Whitewood
Willow Lake
Wilmot
Winner
Wolsey
Wood
Woonsocke
t
Worthing
Wounded Knee
Yale
Yankton
Zell
Zeona
State
---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Marianas Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virgin Islands
Washington
West Virginia
Wisconsin
Wyoming
Zip:
Hire Date:
Employee SSN:
First Name:
Middle Name:
Last Name:
Employee Address:
City
---
Aberdeen
Agar
Akaska
Albee
Alcester
Alexandria
Allen
Alpena
Altamont
Andover
Antelope
Arlington
Armour
Artas
Artesian
Ashland Heights
Ashton
Astoria
Aurora
Aurora Center
Avon
Badger
Baltic
Bancroft
Batesland
Belle Fourche
Belvidere
Beresford
Big Stone City
Bison
Blackhawk
Blunt
Bonesteel
Bowdle
Box Elder
Bradley
Brandon
Brandt
Brentford
Bridgewater
Bristol
Britton
Broadland
Brookings
Bruce
Bryant
Buffalo
Buffalo Gap
Bullhead
Burke
Bushnell
Butler
Camp Crook
Canistota
Canova
Canton
Carthage
Castlewood
Cavour
Centerville
Central City
Chamberlain
Chancellor
Chelsea
Claire City
Claremont
Clark
Clear Lake
Colman
Colome
Colonial Pine Hills
Colton
Columbia
Conde
Corona
Corsica
Cottonwood
Cresbard
Crooks
Custer
Dallas
Dante
Davis
Deadwood
Dell Rapids
Delmont
De Smet
Dimock
Doland
Dolton
Draper
Dupree
Eagle Butte
Eden
Edgemont
Egan
Elk Point
Elkton
Ellsworth AFB
Emery
Erwin
Estelline
Ethan
Eureka
Fairburn
Fairfax
Fairview
Faith
Farmer
Faulkton
Flandreau
Florence
Fort Pierre
Fort Thompson
Frankfort
Frederick
Freeman
Fruitdale
Fulton
Garden City
Garretson
Gary
Gayville
Geddes
Gettysburg
Glenham
Goodwin
Green Grass
Green Valley
Gregory
Grenville
Groton
Hamill
Harrisburg
Harrison
Harrold
Hartford
Hayti
Hazel
Hecla
Henry
Hermosa
Herreid
Herrick
Hetland
Highmore
Hill City
Hillsview
Hitchcock
Hosmer
Hot Springs
Hoven
Howard
Hudson
Humboldt
Hurley
Huron
Interior
Ipswich
Irene
Iroquois
Isabel
Java
Jefferson
Kadoka
Kaylor
Kennebec
Keystone
Kimball
Kranzburg
Kyle
La Bolt
Lake Andes
Lake City
Lake Norden
Lake Preston
Lane
Langford
La Plant
Lead
Lebanon
Lemmon
Lennox
Leola
Lesterville
Letcher
Lily
Little Eagle
Long Lake
Loomis
Lower Brule
Lowry
McIntosh
McLaughlin
Madison
Manderson-White Horse Creek
Marion
Martin
Marty
Marvin
Mellette
Menno
Midland
Milbank
Miller
Milltown
Mission
Mission Hill
Mitchell
Mobridge
Monroe
Montrose
Morristown
Mound City
Mount Vernon
Murdo
Naples
New Effington
Newell
New Holland
New Underwood
New Witten
Nisland
North Eagle Butte
North Sioux City
North Spearfish
Northville
Nunda
Oacoma
Oglala
Okaton
Oldham
Olivet
Onaka
Onida
Orient
Ortley
Parker
Parkston
Parmelee
Peever
Philip
Pickstown
Pierpont
Pierre
Pine Ridge
Plankinton
Platte
Pollock
Porcupine
Presho
Pringle
Pukwana
Quinn
Ramona
Rapid City
Rapid Valley
Ravinia
Raymond
Redfield
Ree Heights
Reliance
Revillo
Rockham
Roscoe
Rosebud
Rosholt
Roslyn
Roswell
St. Charles
St. Francis
St. Lawrence
Salem
Scotland
Selby
Seneca
Sherman
Sinai
Sioux Falls
Sisseton
South Shore
Spearfish
Spencer
Spring Creek
Springfield
Stickney
Stockholm
Storla
Strandburg
Stratford
Sturgis
Summit
Tabor
Tea
Timber Lake
Tolstoy
Toronto
Trent
Tripp
Tulare
Turton
Twin Brooks
Two Strike
Tyndall
Utica
Valley Springs
Veblen
Verdon
Vermillion
Viborg
Vienna
Vilas
Virgil
Vivian
Volga
Volin
Wagner
Wakonda
Wall
Wallace
Wanblee
Ward
Warner
Wasta
Watertown
Waubay
Webster
Wentworth village
Wessington
Wessington Springs
Westport
Wetonka
White
Whitehorse
White Horse
White Lake
White River
White Rock
Whitewood
Willow Lake
Wilmot
Winner
Wolsey
Wood
Woonsocke
t
Worthing
Wounded Knee
Yale
Yankton
Zell
Zeona
State
---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Marianas Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virgin Islands
Washington
West Virginia
Wisconsin
Wyoming
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)