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New Jersey Builders Association
Only Available in New Jersey.

Choose how you would like to load your companies census. We recommend the "Upload A File" option for businesses with more than 15 employees.

Please Note: A Full-Time Employee is defined as an employee working a minimum of 25 hours per week.

We require at least the first of the following employee record cards be filled out. When providing additional employee census records, all five fields within are required.

Adds More Employee Cards.

Attach File(s)

Information needed when submitting an employee census.

  • Employee Name
  • Birth Date
  • Coverage Type:
    • Employee Only
    • Employee & Spouse
    • Employee & Child(ren)
    • Employee, Spouse & Child(ren)
    • Waiving Coverage
  • Employment Status:
    • Full-Time Employee
    • Part-Time Employee
    • Retired
    • Cobra/Continuation
  • Age
Supported File Type(s): CSV, DOC, DOCX, XLS, XSLX, PDF
Supported File Type(s): PDF
Supported File Type(s): PDF

By submitting this form, you allow us to generate as accurate a quote as possible. Quotes provided before working with a member of our marketing team are offered as a guide, as such prices cannot be guaranteed.