Form 26 - Application For Designation As Seasonal Employer
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SD EForm - 0772 V3
HELP
Form 26
(rev. 10/14)
APPLICATION FOR DESIGNATION AS SEASONAL EMPLOYER
South Dakota Department of Labor and Regulation
Unemployment Insurance Division
PO Box 4730, Aberdeen, SD 57402-4730 • Phone 605.626.2312 • Fax 605.626.3347 •
.
See reverse of this form for information regarding the requirements and responsibilities of seasonally designated employers
Owner or Corporate Name
UI Account Number
Business Name or DBA
Address
Address
City
State
Zip Code
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.
Sept.
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 your off season in any of the years listed above, list below the names of
all such individuals, describe their work and give dates of employment.
Add any additional information you consider pertinent to this application.
Signature ____________________________________________________
Date _____________________________
Title ________________________________________________________
Phone _____________________________
Do not write in this space, for SD DLR use only
( ) Approved
( ) Rejected
Date __________________________
Designation ____________________
By _______________________________________________
Registration
CLEAR FORM
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