NDOL | WOTC User Application Form

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Nebraska Good Life. Great Connections. Department of Labor

REEMPLOYMENT
SERVICES

UNEMPLOYMENT
INSURANCE

EMPLOYERS &
BUSINESSES

WORKPLACE SAFETY &
LABOR STANDARDS

REEMPLOYMENT SERVICES

UNEMPLOYMENT INSURANCE

EMPLOYERS & BUSINESSES

WORKPLACE SAFETY & LABOR STANDARDS

WOTC User Application Form

FEIN:

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Address 2:

City:

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Zip:

Contact Information:

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Equal Opportunity Program/Employer

TDD:800.833.7352

For Assistance with Unemployment Insurance - Auxiliary aids and services are available upon request to individuals with disabilities.

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