Document Number: ERD-12192-E
Description: This form is used by Employment Agents to register with the Division. This form should not be used by Licensed Employment Agents.
Comments: This form is an electronic Microsoft Word template that can be filled out on your computer (if you have Microsoft Word). If you do not have Microsoft Word, you should use the ERD-12192 print version that is not fill enabled, and should be printed and completed by hand.
Content Contact: Equal Rights Information
ERD-12192-E (Electronic Version - Word/62 KB)
ERD-12192 (Print Version - pdf/18 KB)
Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.