Form to report unemployment fraud

The Great Seal of the State of New Jersey

To report fraudulent activity, please complete the form below. In order to assist with our investigation, supply all the information that is known to you.

Investigation Information
**
(First, Middle, Last)
The given name of a particular CLAIMANT
-- (xxx-xx-xxxx)
Social Security Number of an INDIVIDUAL. For example:128-76-8090
(Street)
(Address Line 2)
(City, State, Zip as nnnnn-nnnn or nnnnn)
First line of Street Address For example: 1 Main Street,
**
The name of the EMPLOYER for which the CLAIMANT works for
(Street)
(Address Line 2)
(City, State, Zip as nnnnn-nnnn or nnnnn)
Mailing address of the EMPLOYER
**
The textual description of a single instance of PAYMENT METHOD.
The amount of time or period the claimant has been working with the company
The textual name for Claimant's OCCUPATION.
**
The textual description regarding the fraudulent activity

(** indicates a required field)

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