NDOL | WOTC User Application Form

REEMPLOYMENT
SERVICES

UNEMPLOYMENT
INSURANCE

EMPLOYERS &
BUSINESSES

WORKPLACE SAFETY &
LABOR STANDARDS

REEMPLOYMENT SERVICES

UNEMPLOYMENT INSURANCE

EMPLOYERS & BUSINESSES

WORKPLACE SAFETY & LABOR STANDARDS

WOTC User Application Form

FEIN:

Company Name:

Mailing Address:

Address 2:

City:

State:

Zip:

Contact Information:

Name:

Email:

Phone:

Equal Opportunity Program/Employer

TDD:800.833.7352 | TTY:402-471-0016

For Assistance with Unemployment Insurance - Auxiliary aids and services are available upon request to individuals with disabilities.

Our Policies

Acceptable/Intended Use | Accessibility | WIOA Equal Opportunity and Accessibility |

Privacy Statement | Security Information | Technical Support