DWS ESD 630 Form PDF Details

The DWS-ESD 630 form serves as a crucial document for the State of Utah Department of Workforce Services, playing a pivotal role in capturing employment information critical for both employees and employers within the state. Revised in April 2020, this form is designed to facilitate the accurate recording of employment details, including but not limited to new hires, changes in employment status, and the return of employees from leave of absence. To ensure precision, the form mandates completion and signing by the employer, with instructions to use a black pen for clarity. It encompasses a wide array of information such as the company's name, supervisor's contact details, the employment start date, wage details, and work schedule, among others. Furthermore, it delves into specifics like the nature of the employment (temporary or not), educational work study considerations, variations in weekly hours, potential for overtime, and additional financial components like tips, commissions, and bonuses. It also covers essential aspects like health insurance availability, thereby painting a comprehensive picture of an employee's work scenario. The procedure for submission, inclusive of mailing and faxing options, underscores the form's importance in maintaining up-to-date and accurate employment records, thereby facilitating a seamless information flow between the state's workforce system and the entities it serves. With spaces for both employer and employee signatures, the DWS-ESD 630 form ensures accountability and provides a structured framework for employment reporting within Utah.

QuestionAnswer
Form Name DWS ESD 630 Form
Form Length 1 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 15 sec
Other names utah dwsesd, dws esd 630 form pdf, dws 630 form, dws 630

Form Preview Example

DWS-ESD 630 Rev. 04/2020

State of Utah

Department of Workforce Services

EMPLOYMENT INFORMATION

Case name:

 

 

 

 

 

 

 

 

 

 

Case number:

 

 

 

 

 

 

 

 

 

 

 

 

Employed person:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SSN:

 

 

 

 

 

 

 

 

 

 

For new, changes, and returning employment, the entire form must be completed

D11120900160101

 

 

and signed by the employer. Please use a black pen to complete form.

 

 

Employer Information:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Company name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Corporate name (if different):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Payroll company (if different):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Company address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of supervisor or HR contact:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone number:

 

 

Employee Information:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

Date employment began, changed, or returned to work after leave of absence:

 

 

 

2.

Is the employment temporary?

 

Yes

 

 

 

No If yes, what is the expected end date?

 

 

 

3.

Is the employment considered Educational Work Study?

 

Yes

 

No

 

 

4.

Hourly wage: $

 

 

 

 

 

 

 

 

/hr. or Salary: $

 

 

 

 

 

 

/Monthly

/Yearly

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.

Will the number of hours worked each week vary?

 

 

 

Yes

No

 

 

 

If yes, minimum hours:

 

 

 

 

 

 

 

 

 

Maximum hours:

 

 

 

 

 

 

 

 

 

 

 

If no, list the number of hours worked each week:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.

Are there months where this employee works more or less than the hours reported in question 5?

 

(e.g., a teacher who does not work during the summer)

 

Yes

 

No If yes, which months and how many

 

hours will the employee work each week?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.

Is overtime offered on a regular basis?

 

 

 

Yes

No

Weekly overtime hours:

 

 

 

Overtime rate:

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.

How often paid?:

Every two weeks (e.g., every other Friday) List day of the week paid:

 

 

 

Twice per month (e.g., 5th and 20th)

List dates:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Weekly

Monthly

Other:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9.

Date first paycheck will be (or was) received:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What is the estimated gross amount (before taxes)? $

 

 

 

Hours paid on the first check?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10.When does the pay period end (e.g., every other Friday or 15th and 30th)?

11. Does employment include tips, commission, health savings account or shift differential?

Yes

No

If yes, list amount and frequency:

 

 

 

 

 

 

 

 

 

 

 

 

12. Doesemployment include bonuses (e.g., holiday, profit-sharing, performance, etc.)?

Yes

No

 

If yes, list amount and frequency:

 

 

 

 

 

 

 

 

 

 

 

 

13. Does the employer offer health insurance?

Yes

No

 

 

 

 

Is the employee eligible to enroll?

Yes

No

If no why:

 

 

 

 

 

14. If terminated, list the termination date:

 

 

 

Date of final pay check:

 

 

 

 

 

 

 

 

 

 

 

 

Employer Signature*

 

 

 

 

 

 

Date

 

*Additional verification will be required if employer does not sign form.

 

 

 

 

 

 

 

 

 

 

 

 

 

Customer Signature

 

 

 

 

 

 

Date

 

Return form to employee or the Department of Workforce Services:

Mail - Department of Workforce Services, Imaging Operations, P.O. Box 143245, Salt Lake City, UT 84114-3245

Fax - Salt Lake City Area: 801-526-9500 or Toll free: 1-877-313-4717

Equal Opportunity Employer/Program

Auxiliary aids and services are available upon request to individuals with disabilities by calling 801-526-9240. Individuals

who are deaf, hard of hearing, or have speech impairments may call Relay Utah by dialing 711. Spanish Relay Utah: 1-888-346-3162.

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2. The third step would be to fill in these fields: If yes minimum hours If no list, Employee Information Date, Every two weeks eg every other, eg a teacher who does not work, Twice per month eg th and th List, Monthly, Other, hours will the employee work each, Yes, No Weekly overtime hours, Hours paid on the first check, Overtime rate, Maximum hours, Yes, and No If yes which months and how many.

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