RI|--SSN--||--First Name--||-Middle Name--||----Employee's Last Name----||---------Employee's Address 1---------||---------Employee's Address 2---------||---------Employee's Address 3---------||----Employee's City----|ST|ZIP||+4||---------Not used in Illinois----------|sBirth DaHire DatST|--FEIN-||-Not used-||------------------------------------------------------------Not used by HFS' New Hire system-----------------------------------------------------------------------------------------------------------||-----------Not used in Illinois---------||--------------------------------------------------------------Not used by HFS' New Hire system------------------------------------------------------------||-----------Not used in Illinois---------||---------------Filler- Fill With Spaces---------|
W4300303030John                            Doe                           100 Washington St.                      Appt #3A                                                                        Springfield              IL627070001                                         61961021820080715IL123456789