Federal Bonding Program
Use this form to provide information to the Oregon Employment Department to process a federal fidelity bond.
Employer Receiving Bond:
Employer Name / Company Name
*
Company Contact Person
*
Company Contact Person Phone #
*
Company Contact Person Email
*
Company Address
*
Company City/State/Zip
*
Type of Company (NAICS)
*
FEIN
*
Number of Employees at Company
*
Worker to be Covered by Bond:
Last Name
*
First Name
*
Home Address
*
City/State/ZIp
*
Job Title
*
Employee Type
*
W2
1099
Date Worker is Scheduled to Start Work
*
Hourly Wage
*
Hours per Week
*
Reason Worker is Not Otherwise Bondable
*
(justice involved, insufficient credit history, TANF recipient, insufficient references, individuals in recovery, other)
Send me a copy of my responses
Email address
Privacy Policy
|
Report Abuse
Your submission is being processed. Please do not close this browser window until complete.
