Form Dol-Uid-26 - Application For Designation As Seasonal Employer
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1
2SOUTH DAKOTA DEPARTMENT OF LABOR
DOL-UID-26
Rev. 1/02
APPLICATION FOR DESIGNATION AS SEASONAL EMPLOYER
Name of employer: _______________________________________________ No.:________________________
Address:______________________________________________________________________________________
Complete description of business operations: _________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Total number of employees in each month of the years indicated:
Year
Jan.
Feb.
Mar.
Apr.
May
June
July
Aug.
Sep.
Oct.
Nov.
Dec.
20
20
20
When do you usually commence business activity each year (i.e., the date you usually begin
employing more than basic caretaking personnel)? _____________________________________________
When do you usually suspend activities each year (i.e., the date beyond which you employ only
necessary caretaking personnel)? _____________________________________________________________
If you employed anyone during any of the months of November, December, January, February or
March in any of the years listed above, list below the names of all such individuals, describe
their work and give dates of employment.
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Give below any further information you consider pertinent to this application and not included
in the above.
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Date _______________________________
Signature _____________________________________________
Title _________________________________________________
Date ____________________________
(
) Approved
(
) Rejected
Designation _____________________
Benefits ________________________
Bookkeeping _____________________
By _____________________________________________________
(See Reverse Side)
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