Vouchering

Now you can qualify your employees for Enterprise Zone Hiring Credits and recieve valuable credits to reduce your State Income Tax. Just complete this simple form and submit it. We will send you the voucher.

Enterprise Zone Pre-Application

EMPLOYEE Information

Name:
SSN#: XXX-XX-
Home Address:
City:	State: Zip:
Phone:	(xxx) xxx-xxxx
Email:
Job Title:
Starting Hourly Wage:
Date of Hire:	(mm/dd/yy)
The employees position represents: (check one of the following) A New Position or A Previously Existing Position

Employment Information and declaration

Employer Name:
Federal Tax ID Number:
Address (within Zone):
Business Address (if different from Zone address):
Contact Name:
Phone Number:	(xxx) xxx-xxxx
Contact Email:
Declaration: By submitting this voucher application, the employer declares that (1) the company is engaged in a trade or business within the enterprise zone, and, where applicable, (2) the company provided priority for employment to an individual who is enrolled in a qualified program under the federal Job Training Partnership Act or the Greater Avenues for Independence Act of 1985 or who is eligible as a member of a targeted group under the Work Opportunity Tax Credit, or its successor.

Eligibility category

Among other requirements, a Qualified Employee must meet one of the eligibility categories defined in either Sections 17053.74 or 23622.7 of the Revenue and Taxation Code and provide the documentation described in Section 8466 of the California Code of Regulations. From the following list, check the eligibility category under which the employee qualifies:
	California Work Opportunity and Responsibility to Kids (CalWORKS)
	Workforce Investment Act (WIA) (enrolled/eligible for WIA Intensive Services or Core B)
	Work Opportunity Tax Credit (WOTC) or successor program
	Economically disadvantaged individual 14 years of age or older (Must attach the Income Verification Worksheet)
	Dislocated worker under one of the following categories: (Check all that apply)
	Terminated, laid off, received notice of termination or layoff, and eligible for or has exhausted unemployment benefits, and is unlikely to return to his or her previous industry or occupation
	Plant, facility, or enterprise closure. Plant/Company Name:            City/State/Zip:
	Long-term unemployed and has limited opportunities for employment or reemployment
	Formerly self-employed but now unemployed due to general economic conditions
	Former Department of Defense civilian employee at a military installation
	Active member of the armed forces or National Guard as of September 30, 1990
	Seasonal unemployment
	Clean Air Act compliance
	Disabled individual or service-connected disabled veteran
	Vietnam Veteran or veteran recently separated
	Vietnam Veteran or veteran recently separated
	Ex-offender
	Recipient of, or eligible for, Public Assistance (AFDC, SSI, Food Stamps)
	Native American, Native Samoan, Native Hawaiian or member of another group of Native American descent
	Targeted Employment Area (TEA) resident