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

Six months prior to hire, were you enrolled in any of the following programs? Please check all boxes that apply to you:

WIA (Workforce Investment Act) WOTC (Work Opportunity Tax Credit CalWORKS (previously known as GAIN) I am a member of a federally recognized Native American Tribe. I was discharged from the United States Military service within the last 48 months. I served in the United States Military between 8/05/64 and 5/07/75. Within six months prior to hire, I was employed as a migrant worker. I was laid off from my job and return is unlikely. I was unemployed due to plant closure or massive layoff. I have been unemployed for at least 15 of the past 25 weeks prior to hire. I have been convicted of a crime and/or have been on probation. I am 55 years of age or older. I have exhausted all of my Unemployment Insurance.

Six months prior to hiring, were you receiving any of the following? Please check all boxes that apply to you:

AFDC / Food Stamps General Assistance State Disability Supplemental Security Income (SSI) Refugee Cash Assistance Did any family members in your household receive any of the benefits listed above?

Please choose the number of family members living in your household 6 months prior to hire:

Choose... 1 2 3 4 5 6 7

Please choose the amount closest to your total household income 6 months prior to hire:

Choose... $3,835 $6,285 $8,285 $10,645 $12,565 $14,695 $16,825