Form De 8686 - Work Sharing (Ws) - Unemployment Insurance Plan Application

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WORK SHARING (WS)
UNEMPLOYMENT INSURANCE PLAN APPLICATION
1. Enter the following information as shown on the most recent DE 3DP/DE 9423, Quarterly Returns:
Employer Name:
Telephone Number:
(
)
Mailing Address:
California Employer Account Number (Eight Digits):
-
-
2. Enter specific type of business:
3. Enter the employer name that will be used on WS Certifications:
4. Location(s) where WS will occur, if different from Section 1:
Employer Name:
Employer Name:
Address:
Address:
Telephone Number: (
)
Telephone Number:
(
)
R
R
5. Is your business/organization a public entity?
Yes
No
If Yes, enter an "X" in the box next to the type of public entity that best describes your organization:
R
R
R
R
R
R
City
County
State
Federal
School District
Other (Specify)
. Enter effective date of WS plan (New or Renewal):
6
/
/
Note: The earliest effective date for a new WS plan is the Sunday prior to the "first contact date" shown below in the EDD USE
ONLY box. The effective date for a renewed WS plan is the day after the prior plan expires, providing the plan application is
submitted no more than 10 days after the prior plan has expired.
A. If you are renewing your plan, how many additional WS Certifications, DE 4581WS, do you need?
. If you are adding employee(s) or work unit(s) to your existing plan, enter the effective date of the expanded coverage.
7
/
/
Note: The effective date is the Sunday prior to the date the expanded coverage will occur.
FOR EDD USE ONLY
First Contact Date
/
/
EFF. Date
/
/
R
R
R
New WS Plan
Renewal
Expanded WS Coverage
WS ee:
%:
SIC:
Union (Y or N)
Status (T or P)
PAGE ONE OF FIVE
DE 8686 Rev. 14 (12-03) (INTERNET)
CU

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