New York Youth Jobs Program - Confirmation of Hire

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New York Youth Jobs Program - Confirmation of Hire

Please Note: A 2024 confirmation of hire will only be accepted if it is submitted in 2024, not after.

Please have your printer ready to print the confirmation page that appears after you submit this form.

* Indicates required fields

If you have any questions you can contact us at (877) 226-5724 or E-mail

Business Name:

FEIN:

Employee First Name:

Employee Last Name:

Date of Birth (MM/DD/YYYY):

SSN:

Employee Start Date:

Employee Starting Wage:

Hours Per Week:

Part-time (10-34)

Full-time (35+)

First Name of Person Submitting Form:

Last Name of Person Submitting Form:

Phone Number:

Extension:

E-mail:

Agreement

To the best of my knowledge, this information is true, correct and complete. I am aware that there are significant civil and criminal penalties for filing false documents or other information with the government.

By checking this box and submitting this form, I agree to the statement above.

Department of Labor

New York Youth Jobs Program - Confirmation of Hire

Agreement