NextJS frontend for WOTC form filler
Your name Social security number Street address where you live City or town, state, and ZIP code County Telephone number if you are under age 40, enter your date of birth (month, day, year)
[7 checkbox options]
signature with date
REQ: Employer's name Telephone no. EIN Street address City or town, state, and ZIP code
OPT: Person to contact, if different from above Telephone no.
TIME OF OFFER: If, based on the individual’s age and home address, he or she is a member of group 4 or 6 (as described under Members of Targeted Groups in the separate instructions), enter that group number (4 or 6)
Date applicant: gave information was offered job was hired started job
employer signature title date
Applicant Name (Last, First, MI) Social Security Number have you worked for this employer before if yes ...
[a lot of random questions ...]
Employer name Employer address and Telephone EIN