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First Time Employer Report Form (PC-1) 

 

If you are applying for an IDHR Employer Eligibility Number for the First Time, there will be a $75.00 non-refundable fee.  The number expires five (5) years after the date of issue and may be renewed at that time for an additional $75.00 fee.

If your company has multiple locations, the corporate headquarters for the company must submit a First Time Employer Report Form (PC-1) for the location(s) it wishes to register for no additional fee.



Definitions, Clauses & Policies — (PC-1 Form) (Please read before filling out the form)


NO BUSINESS OR PERSONAL CHECKS WILL BE ACCEPTED
   --- only cashier’s check, certified check, or money order will be accepted and processed.  All forms accompanied by a business or personal check will be returned unprocessed.  Also, at this time, we do NOT accept credit cards for first time applications.


First Time Employer Report Form (PC-1) (pdf format)
(First time applicant beginning January 1, 2010)

 

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