What form is used for WOTC?

Employers generally use IRS Form 8850 (Pre-Screening Notice and Certification Request) with ETA forms such as ETA 9061 or state equivalents; the state workforce agency issues certification that permits claiming the credit.

When must it be submitted?

Submit the pre-screening and certification request per state rules; many states require submission within 28 days of hire, so collect and send documentation promptly to preserve eligibility.

Can the employee sign electronically?

Yes. Electronic signatures meet federal ESIGN (15 U.S.C. ch. 96) and state UETA standards when intent, consent, attribution, and record retention are satisfied.

What happens if information is wrong?

Incorrect names, TINs, or missing signatures can prevent state matching and result in denial of certification or disallowance of the claimed tax credit.

How long must documents be kept?

Retain WOTC records consistent with IRS requirements—generally at least 3 years from filing (IRC §6501(a))—and any longer state or program-specific periods.

Does HIPAA affect WOTC forms?

If forms include protected health information, employers must treat them under HIPAA rules and maintain appropriate safeguards; a BAA is required if a vendor handles PHI.

Electronic Signature
Templates
HR
Employee WOTC Form

Employee WOTC Form

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

EMPLOYEE WOTC FORM

Please complete this form in full. The information provided will be used by the employer to determine eligibility for the Work Opportunity Tax Credit (WOTC) and to support required verification. False statements may be subject to penalties. Where additional documentation is required, the employer will advise the employee.

Personal Information

Full legal name Address Phone Email

Date of birth: Last four digits of SSN:

Position Information

Position / Job title Department Reporting manager Anticipated start date Wage / Salary

Employment History (Most Recent)

Employer 1 - Company name Employer 1 - Job title

Start date: End date:

Employer 1 - Primary responsibilities Employer 1 - Reason for leaving

Employment History (Previous)

Employer 2 - Company name Employer 2 - Job title

Start date: End date:

Employer 2 - Primary responsibilities Employer 2 - Reason for leaving

Education

Highest degree or diploma Institution Graduation date Additional coursework or certifications

Professional References

Reference 1 - Name Reference 1 - Phone Reference 1 - Email Reference 1 - Relationship Reference 2 - Name Reference 2 - Phone Reference 2 - Email Reference 2 - Relationship Reference 3 - Name Reference 3 - Phone Reference 3 - Email Reference 3 - Relationship

WOTC Target Group Screening

The employer will use the responses below to determine whether you meet any target group criteria that may qualify for a tax credit. Select all boxes that accurately describe your status on or before your hire date. You must be prepared to provide documentation to support any checked item.

SNAP (Supplemental Nutrition Assistance Program) recipient within the specified lookback period

TANF or state program assistance recipient (Temporary Assistance for Needy Families or comparable program)

Veteran (select if you are a veteran who meets applicable subcriteria)

If veteran, date of discharge:

Ex-felon (released from prison or under court supervision within the specified lookback period)

Recipient of Supplementary Security Income (SSI)

Designated recipient of vocational rehabilitation services

Long-term unemployed (meets employer definition for extended unemployment period)

Summer youth employee (hired for summer employment and meets program age/location requirements)

None of the above / Prefer not to answer

Additional details or notes (provide any dates, program names, case numbers or other details to assist verification):

Legal Disclosures and Authorizations

At-Will Employment: If hired, your employment will be at-will unless otherwise specified in a separate written agreement signed by an authorized representative. Either you or the employer may terminate the employment relationship at any time, with or without cause or notice.

Equal Opportunity: The employer is an equal opportunity employer. Employment decisions are made without regard to race, color, religion, sex, national origin, age, disability, or any other protected status, in accordance with applicable law.

I authorize the employer and its agents to contact prior employers, educational institutions, references and relevant government agencies and to conduct background checks and verification of any information provided on this form for employment and WOTC certification purposes.

I agree to provide any documentation requested by the employer to substantiate my eligibility for WOTC, and I authorize release of such documentation to the employer or its authorized representatives.

Applicant Certification

I certify that the information provided on this form is true, complete and correct to the best of my knowledge. I understand that willful misrepresentation of a material fact may result in denial of WOTC benefits to the employer and may subject me to disciplinary action, including termination.

I certify the information provided is true and I consent to the statements above.

Employer Use Only

Employer representative Date reviewed Documents verified / Notes

WOTC eligibility determination:
Eligible Not eligible

Employer comments

Applicant Printed Name:

Signature:

Date:

What the Employee WOTC Form Is and who it affects

The Employee WOTC Form is the employer-facing paperwork used to identify new hires who may qualify an employer for the Work Opportunity Tax Credit (WOTC). In practice employers use the IRS Form 8850 (Pre-Screening Notice and Certification Request) together with Department of Labor ETA forms (such as ETA 9061) or state equivalents to request certification from the state workforce agency. The forms capture hire data, targeted-group status, and the employee’s signature; certified hires allow employers to claim WOTC on federal payroll tax returns when the supporting documentation is retained and attached to the tax claim.

Why completing the Employee WOTC Form matters

Accurate WOTC screening documents let employers document targeted-group hires and preserve the right to claim federal tax credits that reduce payroll tax liability. Properly completed forms also create an audit trail to support the credit during IRS or state reviews.

Who typically handles Employee WOTC Forms

Several business roles interact with the WOTC process; responsibilities are often shared across hiring, HR, payroll, and tax teams.

HR managers and recruiters who collect pre-screening answers and initiate the certification request during onboarding.
Payroll and tax administrators who retain documentation and apply the approved credit on payroll tax returns.
State workforce agency staff who review submissions and issue WOTC certification or a denial.

Coordination across these groups reduces errors, speeds certification, and ensures the employer retains required records for tax and audit purposes.

Core components of a professional Employee WOTC Form package

A complete WOTC package combines federal/state forms, employee answers, employer attestations, and an auditable signature record so the hiring event can be certified and later substantiated on tax returns.

Pre-screening notice

Includes the employee’s answers to eligibility questions used to determine targeted-group status; it must be completed before or at hire to preserve the candidate’s eligibility for certification.

Certification request

The formal request submitted to the state workforce agency (often using IRS Form 8850 plus ETA 9061 or state form) asking the agency to issue WOTC certification for the hire.

Employee consent & signature

A signature block where the employee attests to the accuracy of responses and consents to the pre-screening; signature date anchors the start of the filing timeline.

Employer attestation

Employer fields capturing hire date, job title, and business contact information plus the employer representative’s signature attesting to the hire and to any calculations used for the credit.

Supporting documentation checklist

Space to list or link supporting docs (e.g., prior TANF paperwork, veteran DD-214) required by the state agency to substantiate targeted-group claims.

Audit trail and submission metadata

Fields and system-generated records that capture submission date/time, signer IP or authentication method, and any attachments to support the certification request.

Required information that must appear on the form

Employee name: Full legal name

Tax ID: SSN or TIN

Hire date: MM/DD/YYYY

Targeted group: Eligibility checkbox

Signature block: Employee signature and date

Employer info: Business name and contact

Step-by-step: filling out the Employee WOTC Form

Follow these core steps to collect, confirm, sign, and submit WOTC paperwork so the hire can be evaluated for certification.

01

Collect data: Gather employee name, SSN/TIN, address, and hire date
02

Complete pre-screen: Record answers to targeted-group questions on the pre-screen form
03

Obtain signatures: Employee and employer sign and date the form
04

Submit: Send Form 8850/ETA form to the state workforce agency

Configuring digital workflows for the Employee WOTC Form

Typical settings to automate collection, authentication, and routing when using an e-signature platform for WOTC paperwork.

Field	Configuration
Authentication	Email link with optional SMS code
Signature Type	Typed, drawn, or uploaded image accepted
Auto-fill	Populate with hire data via CSV or HRIS
Routing	Employer → HR reviewer → archive/state submission

From collection to certification: the submission flow

A compact overview of what happens after the form is completed and signed.

Prepare: Assemble completed pre-screen and supporting documents
Send to signer: Provide employee and employer signing access
Receive signed form: Platform captures timestamp, signer details, and attachments
File to agency: Submit Form 8850/ETA form to the state workforce agency

Digital submission considerations and technical requirements

Ensure your platform supports secure e-signatures, auditable trails, and the file formats required by your state workforce agency.

Integrations: CRM/HRIS connections (Salesforce, NetSuite, Google Workspace)
Formats: PDF and DOCX accepted; keep native copies
Authentication: Email, SMS code, or stronger methods

Confirm state filing rules before eSubmission; keep copies in secure storage that preserves the audit trail and attachments.

Key timing considerations for WOTC submissions

Timing affects whether a new hire can be certified for WOTC. Confirm state-specific windows and preserve the signed form promptly.

Form 8850 submission:

Typically submitted to the state workforce agency within 28 days of hire

Supporting documents:

Provide requested attachments as directed by state agency rules

Payroll reporting:

Apply the credit when filing federal employment tax returns

State variance:

Deadlines and procedures vary by state workforce agency

Record retention:

Keep documentation for the period required by IRS and state rules

Consequences of incorrect or missing WOTC forms

Loss of credit: No certification means you cannot claim WOTC

Disallowed claims: IRS may disallow credits without supporting documentation

Payroll adjustments: You may need to amend payroll tax returns

Administrative delays: Late submission can delay certification decisions

Audit risk: Inadequate audit trail increases audit exposure

Data errors: Incorrect TINs or names impede agency matching

Common mistakes employers make with WOTC forms

Submitting the certification request after the allowed window, which can void eligibility and block the credit.
Entering inconsistent employee names or TINs that prevent state agencies from matching records to the pre-screen.
Omitting the employee signature, date, or required supporting attachments and thereby creating an incomplete submission.
Failing to retain the signed forms and supporting documentation for the period needed to substantiate a claimed credit.

Comparison of eSignature vendor pricing and key capabilities

Common eSignature vendor characteristics relevant to handling WOTC forms: starting price, trial availability, bulk send, audit trails, HIPAA support, and envelope caps.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	Yes, 7-day free trial	Yes	Yes	Yes	Yes
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No envelope cap	100 envelopes/user/year	Varies by plan	Varies by plan	Varies by plan

Real-world examples of WOTC form use

Examples show how employers structure collection and submission to speed certification and preserve the audit trail.

Optica Ventures example

Optica implemented a standard pre-screen at onboarding to catch eligible hires early

They automated routing to payroll
As a result they preserved documentation and reduced manual follow-up across 200 hires per year.

Construction firm example

A mid-size contractor used mobile signing on job sites to capture employee signatures immediately

This avoided late submissions
The company improved documentation completeness and simplified state agency submissions during peak season.

Practical tips to reduce errors and speed certification

Implement these practices to improve accuracy, maintain compliance, and reduce administrative overhead when handling WOTC forms.

Centralize intake

Collect pre-screen answers in a single HRIS or e-sign platform to reduce duplicate data entry and mismatched records.

Confirm identity

Verify SSN/TIN and legal name at onboarding to ensure agency matches and avoid delayed certification.

Time submissions

Submit certification requests promptly; many states require submission within a narrow window after hire.

Retain proof

Keep signed forms, attachments, and the audit trail for the retention period required by IRS and state guidance.

Frequently asked questions about the Employee WOTC Form

Answers to common questions about completing, signing, and submitting WOTC paperwork, plus recordkeeping and e-signature legality.

Need help? Contact support

What form is used for WOTC?
Employers generally use IRS Form 8850 (Pre-Screening Notice and Certification Request) with ETA forms such as ETA 9061 or state equivalents; the state workforce agency issues certification that permits claiming the credit.
When must it be submitted?
Submit the pre-screening and certification request per state rules; many states require submission within 28 days of hire, so collect and send documentation promptly to preserve eligibility.
Can the employee sign electronically?
Yes. Electronic signatures meet federal ESIGN (15 U.S.C. ch. 96) and state UETA standards when intent, consent, attribution, and record retention are satisfied.
What happens if information is wrong?
Incorrect names, TINs, or missing signatures can prevent state matching and result in denial of certification or disallowance of the claimed tax credit.
How long must documents be kept?
Retain WOTC records consistent with IRS requirements—generally at least 3 years from filing (IRC §6501(a))—and any longer state or program-specific periods.
Does HIPAA affect WOTC forms?
If forms include protected health information, employers must treat them under HIPAA rules and maintain appropriate safeguards; a BAA is required if a vendor handles PHI.

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