Current Employer Information Form

CURRENT EMPLOYER INFORMATION FORM Case Number: ATLAS Number: Name of Party Who Will Pay Child Support: That Party's Social Security Number: Name of That Party's Current Employer: Payroll Mailing Address: City: State: Phone Number: Fax Number: Name of That Party's Previous Employer (if known): Payroll Mailing Address: City: State: Phone Number: Fax Number: Your Name: Today's Date: Zip: Zip: Leave this section blank. WA/FSC TYPE OF W/A DATE TYPE OF ORDER EMPLOYER STATUS ENTERED BY NEW W/A SUB AG DCSE Revised June 2011 Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com