Out Of State Employer Questionnaire Form

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(3/2013)
Wyoming Department of Workforce Services
Out of State Employer Questionnaire
The purpose of this form is to help our Department understand the extent of your presence
in Wyoming and enable us to make a proper determination on whether or not you are liable
to Wyoming for Unemployment Insurance and/or Workers’ Compensation taxes.
Your
cooperation in answering the questions completely will be appreciated and will expedite the
processing of your registration.
Complete and Return this form and a Joint Business Registration to:
Employer Services
P.O. Box 2760
Casper, WY 82602
Unemployment Insurance: (307) 235-3217
Workers’ Compensation: (307) 777-6763
Your Company Name:
Address:
City State Zip:
Contact Person Name:
Phone:
1. Has your company been awarded the contract for a project in Wyoming?
Yes
No
If Yes:
What is the project name and location?
Start Date:
How long will this project last?
<1 to 5 months
6 months
7-12 months or more
How long will your company’s work on this project last?
Will your company hire Wyoming residents to work on the project?
Yes
No
Does your company expect to pay salaries over $10,000 per month for
work performed in Wyoming?
Yes
No
2. Is your company a Subcontractor on this project?
Yes
No
If yes, who is the general contractor? Provide business name, address & phone number
3. Is your company a General Contractor on this project?
Yes
No
If yes, who are the subcontractors?
Provide business name, address and phone
number. (If more than 5 subcontractors, attach additional sheets)

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