Employment Information Request 2026 - Connecticut Innovations Connecticut Innovations

Company Background

Name of Company*

Contact Name*

Contact Title

Company Address

Company Mailing Address Company Mailing Address (Line 2) City State / Province / Region Zip/Postal Code Country

Phone

Email

Employee Information

(Full time = more than 35 hours/week; Part time = less than 35 hours/week)

Total employees in Connecticut as of 6/30/2026 (Full Time)*

Total employees in Connecticut as of 6/30/2026 (Part Time)*

Average wage per Connecticut employee (Full Time)*

All full-time employees (including full-time interns).

Average wage per Connecticut employee (Part Time)*

All part-time employees (including part-time interns).

Number of full & part-time Connecticut employees hired between 7/1/2025 through 6/30/2026 (new hires)*

Average wage for new hires in Connecticut as of 6/30/2026*

CI validates job numbers by obtaining the following independent reports. Please upload one of the following: 1. Connecticut Department of Revenue Services (DRS) form UC5A or UC5A Worksheet as of June 30, 2026. 2. DRS form UC2 or UC2 Worksheet as of June 30, 2026. 3. Submission from your company’s payroll service showing or listing jobs as of June 30, 2026. 4. Any other suitable form that is submitted to the DRS that shows jobs as of June 30, 2026. 5. Any form submitted to the Connecticut State Department of Labor that shows jobs as of June 30, 2026.*

Drop files here or

Max. file size: 50 MB.

Name of Preparer*

Name Title

Date*

Contact Elizabeth Skrabl with questions (Elizabeth.Skrabl@ctinnovations.com).

CAPTCHA

Employment Information Request Form 2026

Company Background

Employee Information