This form will be the basic record of YOUR Account.
EMPLOYMENT DEVELOPMENT DEPARTMENT
DO NOT FILE FORM UNTIL YOU HAVE PAID WAGES THAT EXCEED
Taxpayer Assistance Center, Attn: Specialized Coverage Desk
PO BOX 2068
$100.00 IN CALENDAR QUARTER.
RANCHO CORDOVA, 95741-2068
Please read INSTRUCTIONS on the back before completing form.
Fax (916) 464-2904
PLEASE PRIN OR TYPE in BLUE OR BLACK INK ONLY.
Return form to
REGISTRATION FORM FOR GOVERNMENTAL ORGANIZATIONS, PUBLIC SCHOOLS, & INDIAN TRIBES
See reverse for registration instructions for other business types.
EDD ACCOUNT NUMBER
ONLINE PROCESS DATE
A. LIST ALL PRINCIPAL OFFICERS OR
SOCIAL SECURITY #
DRIVER’S LIC #
C. DATE OWNERSHIP
B. BUSINESS NAME:
D. FEDERAL TAX ID #:
(If none, enter N/A)
E. ORGANIZATION OR TRIBE NAME:
F. PHYSICAL BUSINESS LOCATION:
(Number and Street, not P.O. Box)
G. MAILING ADDRESS:
(P.O. Box / Number and Street, only if different than F)
Note: If you have multiple CA locations, please attach the physical business addresses on a separate sheet of paper
H. INDICATE FIRST QUARTER & YEAR WAGES EXCEEDED $100:
First Payroll Date: MM
I. HAVE YOU EVER OWNED OR BEEN A PRINCIPAL OWNER
J. FORMER EDD ACCOUNT NUMBER(S):
IN A BUSINESS REGISTERED WITH EDD?
If Yes, complete J.
NOTE: If necessary, please provide additional information on a separate sheet.
K. WOULD YOU LIKE INFORMATION ON THE FOLLOWING ALTERNATIVE UNEMPLOYMENT INSURANCE FINANCING?
Reimbursable Cost of Benefits
School Employees Fund
Election of Disability Coverage
No, assign tax-rate method
L. TAXPAYER TYPE:
M. COUNTY WHERE BUSINESS IS LOCATED:
(SD) SCHOOL DISTRICT
(OT) OTHER (Specify)
O. NUMBER OF
N. EMPLOYER TYPE:
(07) Public/Charter School
(11) Indian Tribe
(15) State Colleges
(21) Public Entity
(28) State Hospital
(08) District Hospital
(14) University of CA
(16) District Fair
(26) Fed-State Withholding
P. INDUSTRY ACTIVITY: Check the industry, product, or service that represents the greatest portion of your sales or revenue:
Professional Employee Organization
Also, describe specific product and/or service in detail:
Q. CONTACT PERSON FOR BUSINESS:
I certify under penalty of perjury that the above information is true, correct, and complete, and that these actions are not being taken to receive a more
favorable Unemployment Insurance Rate. I further certify that I have the authority to sign on behalf of the above business.
(Officer, Administrator, etc.)
Telephone Number: (
S. PAYROLL TAX EDUCATION
Attend a payroll tax seminar that will help you understand how, what, and when to report State payroll taxes. Visit our Web site at
or call us at (888) 745-3886 for more information.
DE 1GS Rev. 8 (1-11) (INTERNET)
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