Form Bls-700-028 - Master Application - State Of Washington Master License Service - 2000 Page 4
Download a blank fillable Form Bls-700-028 - Master Application - State Of Washington Master License Service - 2000 in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Bls-700-028 - Master Application - State Of Washington Master License Service - 2000 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
44. Employment
Complete if you employ, or plan to employ, one or more persons in Washington; or if you want optional coverage under this ownership.
a.
Date of first employment or planned employment at this location.
/
/
First date wages paid.
/
/
MM
DD
YY
MM
DD
YY
b.
Number of persons you employ or plan to employ at this location (Do not include owners):
c.
Estimate the number of persons under 18 (minors) you will employ in the next 12 months:
Estimate number of minors that will be under 16:
Are any of the minors working in an agricultural business?
Yes
No
List the specific duties performed by minors at this location:
d.
If you operate at more than one location, do you wish to report the employee information at the locations:
Together
Separately
e.
Do you want unemployment insurance coverage for corporate officers?
Yes — Prior to coverage, Form 5203 is required. This form will be sent to you by Employment Security Department.
No — The corporation must inform officers in writing that they are not covered for unemployment insurance.
f.
If you want industrial insurance for sole proprietor(s), partners, owners, corporate officers or LLC members, mark this box.
Yes — Prior to coverage, Form F213-042-000 is required. Form will be sent to you by Dept. of Labor & Industries.
g.
If you want optional industrial coverage for excluded employment, mark this box. (See License Fee Sheet for descriptions.)
Yes — Prior to coverage, Form F213-112-000 is required. Form will be sent to you by Dept. of Labor & Industries.
h.
If your entity is a Limited Liability Company, is your management vested?
Yes — If managers are also members, they are exempt from industrial insurance coverage.
No — If managers are not members, they are mandatorily covered for industrial insurance coverage.
i.
Please check the ONE box, which best describes the major operation of your business and provide activity in detail below.
(01) Construction-Wood Frame Bldg.
(05) Shipbuilding
(09) Mfg. - Food Products
(13) Retail/Wholesale Trade
(02) Construction-All other
(06) Mining/Quarrying/Sand & Gravel
(10) Miscellaneous Mfg.
(14) Services/Maint./Restaurants
(03) Logging/Forestry/Trucking
(07) Mfg. - Wood/Metal/Stone Products
(11) Machine Shops/Auto Repair
(15) Communications
(04) Temp. Help/Employee Leasing
(08) Mfg. - Chemicals
(12) Agricultural/Farming
(16) Clerical/Professional Occup.
3-Month Estimate
j.
Describe in detail the activities of your employees and/or indicate the category
Number of
Workers’ Hours
of optional coverage for excluded employment requested:
Employees
(Include Minors)
5. Signature
Signature of sole proprietor or spouse, partner, corporate officer, or limited liability member/manager.
I, the undersigned, declare under the penalties of perjury and/or the revocation of any license granted, that I am the applicant
or authorized representative of the firm making this application and that the answers contained, including any accompanying
information, have been examined by me and that the matters and things set forth are true, correct and complete.
X
/
/
Signature Required
Date
(
)
/
/
Application Prepared By (Please Print)
Title
Telephone No.
Date
(
)
/
/
UBI Agency Representative
Telephone No.
Date
1
4 of 4
BLS-700-028 MASTER BUSINESS APP. (R8/00) OR Page
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal