INSTRUCTIONS FOR A NEW REGISTRATION
APPLICATION FOR EMPLOYER FEE PAID EMPLOYMENT AGENCY REGISTRATION Application must be accompanied by: A check or money order for the required registration fee of $150.00 payable to the Connecticut Department of Labor. A certificate of assumed or trade name as filed in Town Clerk's office if applicant is sole-proprietor or partnership If a corporation/limited liability company/limited liability partnership, your status as a Connecticut corporation/limited liability company/limited liability partnership, or authority to do business in Connecticut must be on file with the Connecticut Secretary of States' office. A computer search will be conducted by this office to make sure your business is registered with the Connecticut Secretary of States' office. If records do not indicate that you are active and in good standing, we will be in touch with your agency for additional paperwork Proof of Workers' Compensation insurance with complete Workers' Compensation Information form (PROOF OF WORKERS' COMPENSATION IS A CERTIFICATE OF INSURANCE) Corporations or Limited Liability Companies with no employees can be exempted from carrying Workers' Compensation Insurance for their officers or members by completing a Workers' Compensation Form 6b. Partnerships or Limited Liability Partnerships with no employees can be exempted from carrying Workers' Compensation Insurance by having the partners complete a Workers Compensation Form 6b1. Please contact this office if you need information on the Form 6b or 6b1. The original forms should be submitted to your local Workers' Compensation District office and copies sent to our office with your registration forms and fee.
The following should be complied with: Contact the Department of Revenue Services at (860) 297-4885 for sales tax regulations required on agency fees. Contact Wage & Workplace Standards Division at (860) 263-6790 for wage and hour regulations. Additional information: *Enclosed is information regarding employer/employee responsibilities under the Connecticut Unemployment Compensation Law.
Questions concerning this application or paperwork to be submitted may be addressed to:
Gary K. Pechie, Director Connecticut Labor Department Wage & Workplace Standards Division 200 Folly Brook Boulevard Wethersfield, CT 06109-1114 Telephone: (860) 263-6791
STATE OF CONNECTICUT DEPARTMENT OF LABOR
WAGE & WORKPLACE STANDARDS DIVISION 200 FOLLY BROOK BOULEVARD WETHERSFIELD, CT 06109-1114
APPLICATION FOR EMPLOYER FEE PAID EMPLOYMENT AGENCY REGISTRATION
I(We) Doing Business as: Business address: (Street Address - Registration cannot be issued to a Post Office Box) ( ) (Business Telephone Number) hereby apply for a registration
(City) Please list additional locations on reverse side Owner is: Sole-Proprietorship If business is:
Sole Proprietorship - list owner. Partnership - list all partners. Corporation - list all officers and directors. Limited Liability Company - list all members. Home Address Title
Please provide your social security # (SSN) (FEIN) .
or your federal employer identification number
I (We) certify that the information provided on this application for Employer Fee Paid Employment Agency Registration is true and accurate.
Signature(s) of Officers, Members, Partners or Proprietor
************************************************************************************************************************************************************************ (For Department of Labor Use Only) Approved By: Issuance Date: Effective Date: Date
WORKER'S COMPENSATION INSURANCE
You MUST return this form with the requested information
Section 31-286a of the Connecticut General Statutes requires that any applicant for a license or permit and/or renewal of the license or permit who has employees in the State of Connecticut, must first provide a CURRENT certificate of Worker's Compensation Insurance in order for us to ISSUE or RENEW YOUR LICENSE or REGISTRATION.
Print, business name
Please check one (1) box:
) I do not have any employees Print business address
) I have (an) employee(s) and have enclosed Worker's Comp. Insurance Certificate.
' Print your name
scam. CERilFlCATE OF INSURANCE
ISSUE DATE (MMIDDIYY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
COMPANY A LETTER COMPANY B LETTER COMPANY LETTER
COMPANY ,, LETTER COMPANY LETTER
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO INDICATED, NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTR CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN ) R
TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE P DATE (MMIDDIYY)
EIN IS SUBJECT TO ALL THE TERMS,
COMMERCIAL GENERAL LIABILITY CLAIMS MADE x OCCUR.
AGG. $ $
L ADV. INJURY
OWNER'S & CONTRACTOR'S PROT.
ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS GARAGE LIABILITY
EACH ACCIDENT AND DISEASE-POLICY LIMIT
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEd BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAI,1. c DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
@ACORD CORPORATION 199 `7 "
RESPONSIBILITIES OF REGRISTRIES, EMPLOYMENT AGENCIES TEMPORARY HELP AGENCIES, EMPLOYEE LEASING COMPANIES, AND PROFESSIONAL EMPLOYER ORGANIZATIONS UNDER THE CONNECTICUT UNEMPLOYMENT COMPENSATION LAW
Any individual who is referred to a client and is subsequently paid by the Registry/Agency may be considered an employee of the Registry/Agency. The Registry/Agency is acting as a temporary help agency when they pay the individual directly; the wages paid are subject to the Connecticut Unemployment Compensation Law. Individuals employed in this manner over one (1) year are considered leased employees. Such agencies should refer to the Department's leasing policy. If an individual is referred to a client (commercial, domestic, or agricultural), the Registry/Agency receives only a placement fee and does not pay the individual's wages, then the individual is not considered an employee of the Registry/Agency. However, this does not automatically make the individual an Independent Contractor regarding his or her employment status with the client under the Connecticut Unemployment Compensation Law. The individual will be considered a full or part-time employee of the client who pays the individual's wages, unless the individual is a valid Independent Contractor excluded from employment as defined in Section 31-222(a) (1) (B) (ii) of the Connecticut Unemployment Compensation Law. In a Connecticut Supreme Court decision dated August 14, 1990, (Walter N. Latimer v. Administrator, U. C. Act (13863) ), it was stated that personal care assistants (PCA's) placed by a registry/Agency with a client who paid the PCA's were employees of the client. The Court ruled that "The fact that the PCA's placed with the client by the registry signed an agreement that they were "independent contractors" is of no moment. Such provisions in a contract are not effective to keep an employer outside the purview of the Act when the established facts bring him within it." Registries/Agencies should not advise their clients that the referred individual is an Independent Contractor. The Registry/Agency should inform their clients that the referred individual may well be considered the client's employee. Questions regarding employee vs. Independent Contractor status should be referred to the Connecticut Labor Department, Field Audit Unit. The telephone number at the Central Office location, 200 Folly Brook Boulevard, Wethersfield, CT 06109-1114, is (860) 236-6360. Local Field Audit Locations and telephone numbers are listed on the reverse side.
Unemployment Tax Policy Concerning Employee Leasing Companies Revised October 1, 1998 Definitions. (a) "Employee leasing company" means an employing unit that contracts with a client company to supply workers to perform services for the client company, provided that, the term employee leasing company does not include a temporary help company that provides temporary employees to others. "Employer Status Unit" means the unit within the Department of Labor that registers employers in the State of Connecticut whose mailing address is 200 Folly Brook Boulevard, Wethersfield, Connecticut 06109. "Temporary employee" is an individual hired by a temporary help company to provide service to another business for a finite period of time, not exceeding one year and such individual shall not have been on the payroll of the client business to which he or she has been assigned to work by a temporary help company within the sixty days immediately preceding his or her employment as a temporary employee. "Temporary help company" means any person conducting a business which consists of employing individuals directly for the purpose of furnishing full-time or part-time temporary employees to others to provide services for a finite period of time, not to exceed one year.
Registration of Employee Leasing Companies and Their Clients. (a) Each employee leasing company, doing business in the State of Connecticut, shall register with the Employer Status Unit of the Department of Labor. Employee leasing companies shall provide the Employer Status Unit with a list of its client companies upon its initial registration, and thereafter annually by January 31st, listing all clients as of the immediately preceding December 31st. Such list shall include: (1) client's name; (2) client's address; (3) client's Connecticut unemployment compensation registration number; and (4) client's federal employer identification number. (c) A client who is a new employer, or who has not previously registered with the Employer Status Unit shall establish its Connecticut unemployment registration number by filing an Employer Status Report with the Employer Status Unit.
Connecticut Department of Labor Unemployment Tax Policy Concerning Employee Leasing Companies Revised October 1, 1998 Reporting of Contributions. Payroll Records. (a) A properly registered employee leasing company may file employer quarterly contribution returns and pay contributions on behalf of its client companies. Such reporting and payment of contributions shall be done under the client company's Connecticut unemployment compensation registration number and at the experience rate assigned to the client company by the Department of Labor. Each employee leasing company shall keep payroll records in such a manner so that separate records may be produced for each of its client companies. Sole proprietors, partners and owners/members of limited liability companies having a federal income tax filing status of a sole proprietor or partnership will not become covered employees for the purpose of unemployment compensation by entering into an employee leasing agreement. Employee leasing companies shall calculate separate taxable wage bases for leased employees who work for more than one client during the same calender year.
Experience Rates for Client Companies. (a) Annually, the Department of Labor shall establish the experience rates for each client company of the employee leasing company based on each client company's experience as an employer. The Department shall charge unemployment insurance benefit against the client company's account in accordance with Section 31-225a of the Connecticut General Statutes.
Power of Attorney. Notification of Changes. (a) The Department shall mail all correspondence and provide information pertaining to the reporting, contributions and experience rating of its client companies to the employee leasing company if the employee leasing company has filed documentation of a Power of Attorney with the Employer Status Unit. Such Power of Attorney must specify the employee leasing company's address as the official address of record for the client company. Employee leasing companies shall notify the Employer Status Unit in writing within ten days of termination of leasing services to a client. Such notice shall state the last pay date and the client's current address.
Please direct questions to the Employer Status Unit at 860-263-6550. Jerry Fleming Acting U.C. Director of Accounts
FIELD AUDIT UNIT LOCATIONS AND TELEPHONE NUMBERS
350 Fairfield Avenue, Suite 602, BRIDGEPORT 06604 Telephone Number (203) 455-2725 152 West Street, DANBURY 06810 Telephone Number (203) 797-4148 620 Enfield Street, ENFIELD 06082 Telephone Number (860) 741-4285 39 Marne Street, HAMDEN 06515 Telephone Number (203) 859-3325 3580 Main Street, HARTFORD 06120 Telephone Number (860) 256-3725 645 South Main Street, MIDDLETOWN 06457 Telephone Number (860) 754-3130 260 LaFayette Street, NEW BRITAIN 06053 Telephone Number (860) 827-7063 Shaw's Cove Six, NEW LONDON 06320 Telephone Number (860) 439-7550 113 Salem Turnpike, Suite 101, NORWICH 06360 Telephone Number (860) 859-5700 Torrington Parkade, 486 Winsted Road, TORRINGTON 06790 Telephone Number (860) 626-6221 249 Thomaston Avenue, WATERBURY 06702 Telephone Number (203) 437-3400 1320 Main Street, WILLIMANTIC 06226 Telephone Number (860) 423-2689
ANSONIA 555 Main Street a Ansonia, CT 06401 (203) 736-1068 BRIDGEPORT 35 Courtland Street Bridgeport, CT 06604 (203) 579-6274
HAMDEN 39 Marne Street Hamden, CT 065 14 (203) 789-7769
NEW BRITAIN 260 Lafayette Street New Britain, CT 06053 (860) 827-706317064 NEW LONDON Shaw's Cove Six New London, CT 06320 (860) 447-6206
WATERBURY 249 Thomaston Avenue Waterbury, CT 06702 (203) 596-4144 WETHERSFIELD 200 Folly Brook Blvd. Wethersfield, CT 06 109 (860) 263-6360 (~fr. 12-14-98) (860) 566-5304 (Old) WILLIMANTIC 1320 Main Street, Tyler Square Willimantic, CT 06226 (860) 423-2689
3580 Main Street, 2nd Floor Hartford, CT 06120 (860) 566-5 150
BRISTOL 55 South Street Bristol, CT 06010 (860) 584-4795 DANBURY 152 West Street Danbury, CT 068 10 (203) 797-4148
MANCHESTER 587 East Middle Turnpike Manchester, CT 06040 (860) 643-3008 MERIDEN 290 Pratt Street P. 0. Box 708 Meriden, CT 06450 (203) 238-6115 MIDDLETOWN 645 South Main Street Middletown, CT 06457 (860) 344-2232
NORWICH 113 Salem Turnpike North Bldg. Suite 101 Norwich, CT 06360 (860) 859-5700 STAMFORD 1340 Washington Blvd., Room 207 P. 0. Box 3831 Stamford, CT 06905-083 1 (203) 425-2428 TORRlNGTON 486 Winsted Road Torrington, CT 06790 (860) 626-622 1
ENFIELD 620 Enfield Street Enfield, CT 06082 (860) 741-4285