Application for Permit to Maintain Payroll Records Outside of New Jersey

The Great Seal of the State of New Jersey

STATE OF NEW JERSEY

DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT

DIVISION OF WAGE AND HOUR COMPLIANCE

Employer Information
**
The official name of the organization applying for an permit to maintain records outside of the state of NJ.
**
(First, Middle, Last)
The of the person requesting permit to maintain records outside of the state of NJ.
**
(Street)
(Address Line 2)
(City, State, Zip as nnnnn-nnnn or nnnnn)
The official name of the company applying for an permit to maintain records outside of the state of NJ.
**
Federal government identification for a particular company
**
A division of a state associated with a company's address
**
A number to contact the company
(333)333-3333
Additional contact information
(333)333-3333
Additional contact information
yourname@abc.com
Additional contact information

(** indicates a required field)

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