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ER ADDRESS: RETURN TO: NHES -NEW HIRE PROGRAM PO BOX 2092 CONCORD NH 03302-2092 FAX (603) 226-4324 OR 1-888-783-3598 EMPLOYER TELEPHONE NO : ( EMPLOYER FAX NO : ( ) ) Note: For Type of Hire write W for W-2 EMPLOYEE or I for 1099 INDEPENDENT CONTRACTOR EMPLOYER CONTACT PERSON : SOCIAL SECURITY NO.

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