Form DBPR ELC3 "Application for Licensure as an Employee Leasing Company Group" - Florida

What Is Form DBPR ELC3?

This is a legal form that was released by the Florida Department of Business & Professional Regulation - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2013;
  • The latest edition provided by the Florida Department of Business & Professional Regulation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DBPR ELC3 by clicking the link below or browse more documents and templates provided by the Florida Department of Business & Professional Regulation.

ADVERTISEMENT
ADVERTISEMENT

Download Form DBPR ELC3 "Application for Licensure as an Employee Leasing Company Group" - Florida

1109 times
Rate (4.4 / 5) 55 votes
1 of 32
State of Florida
Department of Business and Professional Regulation
Board of Employee Leasing Companies
Application for Licensure as an Employee Leasing Company Group
Form # DBPR ELC 3
EMPLOYEE LEASING COMPANY GROUP QUALIFICATIONS
Two or more, but not more than five, employee leasing companies that are majority owned by
the same ultimate parent, entity, or persons may be licensed as an employee leasing company
group.
As a condition of licensure as an employee leasing company group, each company that is a
member of the group shall guarantee payment of all financial obligations of each other member.
Group members must complete the Cross Guarantee form included in this packet (pages 20 and
21).
Each employee leasing company in the group must have at least one properly licensed
controlling person, however the same person could be the controlling person for multiple group
members. For additional information regarding who should be licensed as a controlling person,
please see the controlling person application (form # DBPR ELC 1) and its instructions which
are included in this application packet (pages 24-32).
An Employee Leasing Company Group is required to have a tangible accounting net worth of
not less than $50,000 collectively, and positive net working capital. If the employee leasing
company group does not have a tangible accounting net worth of at least $50,000, the group
shall have guaranties, letters of credit, or other securities acceptable to the board in sufficient
amounts to offset any deficiency. If you require a guaranty or letter of credit, Board approved
guaranty and letter of credit forms are included in this application packet (pages 22 and 23).
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION REQUIREMENTS
ALL Employee Leasing Company Group Applicants must submit:
Fees:
• Application Fee- $250 non-refundable application fee for each member company.
• License Fee- $1,500, if application is filed in the first year of the employee leasing biennium;
$750, if application is filed in the second year of the biennium. The biennium ends on April 30 of
every even-numbered year. This fee only applies to the Group Leader.
• Pay the Employee Leasing Company Assessment Fee based on the company’s gross Florida
payroll. Your application will not be complete until you pay the assessment fee. Note: If you are
an existing group licensee adding a company to the group, an additional assessment is
not required.
Please see 61G7-5.002 F.A.C to determine the Annual Assessment Fee.
o
• Make all checks payable to the Florida Department of Business and Professional Regulation.
Complete application form # DBPR ELC 2- Application for Licensure as an Employee Leasing
Company.
• Complete Section XII- Historical Sketch, on pages 15-17 of this application packet. Rule 61G7-
5.0012, Florida Administrative Code requires that all applicants complete this form to disclose
individuals who directly or indirectly control a specified percentage of voting stock, and/or are
directors or principal officers of the applicant or its ultimate parent. The following individuals are
required to submit Historical Sketches:
Individuals directly or indirectly controlling 20% or more of the voting stock of the
o
applicant or ultimate parent, if the applicant or its ultimate parent is a publicly traded
company.
Individuals directly or indirectly controlling 10% or more of the voting stock of the
o
applicant or ultimate parent, if the applicant or its ultimate parent is a closely held
company.
All directors or principal officers of the applicant or its ultimate parent.
o
For more information about Historical Sketch reporting requirements see
Rule 61G7-
o
5.0012, Florida Administrative Code.
DBPR ELC 3 Employee Leasing Company Group
2013 August
Incorporated by Rule: 61-35.013
1 of 32
State of Florida
Department of Business and Professional Regulation
Board of Employee Leasing Companies
Application for Licensure as an Employee Leasing Company Group
Form # DBPR ELC 3
EMPLOYEE LEASING COMPANY GROUP QUALIFICATIONS
Two or more, but not more than five, employee leasing companies that are majority owned by
the same ultimate parent, entity, or persons may be licensed as an employee leasing company
group.
As a condition of licensure as an employee leasing company group, each company that is a
member of the group shall guarantee payment of all financial obligations of each other member.
Group members must complete the Cross Guarantee form included in this packet (pages 20 and
21).
Each employee leasing company in the group must have at least one properly licensed
controlling person, however the same person could be the controlling person for multiple group
members. For additional information regarding who should be licensed as a controlling person,
please see the controlling person application (form # DBPR ELC 1) and its instructions which
are included in this application packet (pages 24-32).
An Employee Leasing Company Group is required to have a tangible accounting net worth of
not less than $50,000 collectively, and positive net working capital. If the employee leasing
company group does not have a tangible accounting net worth of at least $50,000, the group
shall have guaranties, letters of credit, or other securities acceptable to the board in sufficient
amounts to offset any deficiency. If you require a guaranty or letter of credit, Board approved
guaranty and letter of credit forms are included in this application packet (pages 22 and 23).
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION REQUIREMENTS
ALL Employee Leasing Company Group Applicants must submit:
Fees:
• Application Fee- $250 non-refundable application fee for each member company.
• License Fee- $1,500, if application is filed in the first year of the employee leasing biennium;
$750, if application is filed in the second year of the biennium. The biennium ends on April 30 of
every even-numbered year. This fee only applies to the Group Leader.
• Pay the Employee Leasing Company Assessment Fee based on the company’s gross Florida
payroll. Your application will not be complete until you pay the assessment fee. Note: If you are
an existing group licensee adding a company to the group, an additional assessment is
not required.
Please see 61G7-5.002 F.A.C to determine the Annual Assessment Fee.
o
• Make all checks payable to the Florida Department of Business and Professional Regulation.
Complete application form # DBPR ELC 2- Application for Licensure as an Employee Leasing
Company.
• Complete Section XII- Historical Sketch, on pages 15-17 of this application packet. Rule 61G7-
5.0012, Florida Administrative Code requires that all applicants complete this form to disclose
individuals who directly or indirectly control a specified percentage of voting stock, and/or are
directors or principal officers of the applicant or its ultimate parent. The following individuals are
required to submit Historical Sketches:
Individuals directly or indirectly controlling 20% or more of the voting stock of the
o
applicant or ultimate parent, if the applicant or its ultimate parent is a publicly traded
company.
Individuals directly or indirectly controlling 10% or more of the voting stock of the
o
applicant or ultimate parent, if the applicant or its ultimate parent is a closely held
company.
All directors or principal officers of the applicant or its ultimate parent.
o
For more information about Historical Sketch reporting requirements see
Rule 61G7-
o
5.0012, Florida Administrative Code.
DBPR ELC 3 Employee Leasing Company Group
2013 August
Incorporated by Rule: 61-35.013
2 of 32
NOTE: Any individual who holds a current controlling person license or who will
o
be submitting a controlling person application with this packet DOES NOT need
to complete a historical sketch.
Make additional copies as necessary.
o
• Complete the controlling person application, Form # DBPR ELC 1, on pages 24-32 of this
application packet, for each person who will need to be licensed as a controlling person for this
employee leasing company who is not already a licensed controlling person. Make additional
copies as necessary.
• Complete and sign the Quarterly Compliance Form, Form # DBPR EL 4522, on page 18 of this
application packet.
• Health Insurance Statement (Form # DBPR EL 4507, page 18 of this packet) completed by
your insurance provider stating that the plan of insurance is a fully-insured plan. If the insurance
provider refuses to sign the statement, you must provide a complete copy of each health
insurance policy. This is only required if providing health insurance to leased employees.
• Complete a Cross Guarantee Form, Form # DBPR EL 4518, on pages 20-21 of this application
packet.
Submit all required Exhibits and label them according to their exhibit number.
Required Exhibits: Please attach the following documents and label them as the exhibit numbers
indicated.
Note:
ALL exhibits must be attached or enclosed. If the documents requested in a particular
exhibit do not apply to you, submit a page referencing that exhibit number and include on that
page an explanation as to why the requested information does not apply. Please submit ALL
documentation on 8 ½ x 11 paper.
Exhibit 1: Certificate of Good Standing or Authority from Florida Secretary of State’s office. For
more information on how to obtain this document, contact the Secretary of State, Division of Corporations
at 850.488.9000.
Exhibit 2: Workers’ Compensation Certificate of Insurance (COI). Attach a COI from the workers’
compensation insurance provider for each policy held. The provider must be an admitted carrier in the
State of Florida. The COI must name the employee leasing company as the insured, name the
Board of Employee Leasing Companies (including address) as the certificate holder, include a 30-
day notice of cancellation, bears the signature of an authorized representative of the insurance
provider, and state that it covers all leased employees in this state.
Exhibit 3: Contractual Agreement- Attach a copy of the contractual agreement which will be used
after licensure to engage in employee leasing with client companies. The agreement must meet the
requirements of Section 468.525(4), Florida Statutes. A contract provisions checklist is included in this
application packet (page14) to help applicants comply with this requirement. Please complete and submit
the Contract Provisions Checklist along with a copy of the contractual agreement. Note: Each contract
must exactly reflect the name of the company applying for licensure.
Exhibit 4: Accrual Basis Financial Statements.
Attach accrual basis financial statements as determined by generally accepted
accounting principles as of the date of the most recent fiscal year end. The financial statements
shall include a Balance Sheet, Statement of Income and Retained Earnings, Statement of
Cash Flows, and Notes to the Financial Statements. The financial statements are to reflect
positive working capital and a minimum $50,000 tangible accounting net worth.
The financial statements must be audited or reviewed by an independent certified public
accountant. If the leasing company has a gross Florida payroll of $2,500,000 or above, audited
financial statements are required. If gross Florida payroll is less than $2,500,000, reviewed
financial statements are acceptable.
Be advised that even if you are a newly organized company or an older inactive
company, you must still comply with the audit or review requirement. In cases where the
company has not been in existence long enough to have fiscal year-end financial statements, you
must provide audited or reviewed financial statements as of a given quarter end or month end.
If your fiscal year end was more than 120 days from the date you filed this application,
provide the fiscal year-end statements and a statement from management certifying that there
have been no material adverse changes in the financial position of the company since the date of
the last financial statements. It is suggested that you also provide a recent interim financial
statement which reflects the current financial status of the company. The interim financial
statements need not be audited or reviewed.
DBPR ELC 3 Employee Leasing Company Group
2013 August
Incorporated by Rule: 61-35.013
3 of 32
Exhibit 5: Copies of UCT-6 Forms. The UCT-6 form is the Florida Department of Revenue
Employer’s Quarterly Report form. This form will be used to determine the amount of assessment due.
Please attach a copy of the UCT-6 forms filed with the Florida Department of Revenue for the preceding
calendar year. In the event no wages were paid during the preceding calendar year, please provide a
statement from management stating such.
Exhibit 6: State Taxes Letter of Good Standing. If domiciled outside the State of Florida or if you
have operations in other states, provide documentation from each state as evidence that payroll taxes,
unemployment taxes, etc., are current in those states.
Exhibit 7: State License Letter of Verification/Good Standing. Please submit a letter of
verification/good standing for each state in which you hold a license to practice as an employee leasing
company/group.
Exhibit 8: IRS Form 8821. Complete
IRS Form 8821
for each employee leasing company. Return the
completed form(s) with your application. It may be forwarded to the Internal Revenue Service (IRS) for
processing. The purpose of this form is to determine if there are any delinquent taxes or penalties due
from the employee leasing company.
Complete the following items on the form:
Instructions for completing IRS Form 8821:
Complete the following items on the form:
1. Taxpayer information
This must be the name of the applicant.
o
2. Appointee
This must be named Florida Department of Business and Professional Regulation -
o
Employee Leasing Board, 2601 Blair Stone Road, Tallahassee, Fla. 32399.
3. Tax matters:
The appointee is authorized to inspect and/or receive confidential tax information in any
o
office of the IRS for the tax matters listed on this line. You must list forms 940 and 941 as
well as any additional forms the applicant will be filing.
Year(s) or period(s) must include the current year, past two (2) years and three (3) future
o
tax periods.
4. Complete # 4 specific use not recorded on centralized authorization file.
You must check off # 4 on this section.
o
5. The applicant must sign and date this section of the form.
Exhibit 9: Cross Guarantee Form, DBPR EL 4518. This form must include all companies in the
group.
Instructions
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395.
1. Application Instructions by section
a. Section I- Application Type
i. Select “Applying as a Group Leader” if you will be applying as the group leader.
ii. Select “Applying as Member of a NEW Group License” if you will be applying to form a
new employee leasing company group that has not been previously licensed.
iii. Select “Applying as Member of an Existing Group License” if you will be joining an
existing employee leasing company group. Provide the group license number.
iv. Provide the information for the leader of the employee leasing company group.
b. Section II- Company Information
i. Fill out each section completely.
ii. In the Company Name section, applicants must provide their full legal name as filed
with the Secretary of State, Division of Corporations. Do not use any nicknames,
aliases, or initials.
iii. If your company plans to operate under a fictitious name, list the fictitious name as
listed on the certificate from the Secretary of State’s office that you have been
approved to do business under this name.
iv. A Federal Employer ID Number (FEID) is required in order to apply for a company
license within the Department of Business and Professional Regulation.
DBPR ELC 3 Employee Leasing Company Group
2013 August
Incorporated by Rule: 61-35.013
4 of 32
v. Provide the Unemployment Tax Identification Number given by the Florida Division of
Unemployment Compensation or the Internal Revenue Service.
vi. Please select the type of business of the employee leasing company
vii. Provide the Corporation Identification Number, Organization Date and Fiscal Year End
of company as listed with the Florida Division of Corporations.
viii. Provide your mailing address. This will be used for sending correspondence regarding
your application and license.
ix. Provide the company location address if different from the mailing address.
x. Provide a contact name, valid phone number and email address. Contact information is
often used to quickly resolve questions with applications by telephone call or email. If
contact information is not provided, questions regarding applications will be mailed to
the applicant’s mailing address and may take longer to resolve. Providing your email
address is a public record.
xi. Provide the Registered Agent information for the company as designated with the
Florida Secretary of State’s office.
c. Section III- Company Ownership
i. Provide the names, addresses, titles, social security numbers, and percentage of
ownership which totals 100% of the company’s ownership. Officers, managers, and
controlling persons must also provide this information.
ii. If already licensed as a controlling person, provide the license number. If not, answer if
you will or will not be submitting a controlling person application packet.
d. Section IV- Company Background Information
i. Question 1:
1. (a) If you answer “yes” to this question, you must complete Section V [make
additional copies as necessary] of the application and provide a copy of the
arrest report, copies of the disposition or final order(s), and documentation
proving all sanctions have been served and satisfied. You must supply this
documentation for each occurrence. If you are unable to supply this
documentation, a certified statement from the clerk of court for the relevant
jurisdiction stating the status of records is required.
If you are still on probation, you must supply a letter from your probation officer,
on official letterhead, stating the status of your probation.
2. (b) If you answer “yes” to this question, you must complete Section VI [make
additional copies as necessary] of the application by explaining the nature of the
license, registration or certification refusal.
3. (c) If you answer “yes” to this question, you must complete Section VI [make
additional copies as necessary] of the application by providing an explanation for
the action against your license and supply copies of the order(s) showing the
disciplinary action taken against the license, or documentation showing the
status of the pending action.
4. (d) If you answer “yes” to this question, you must complete Section VI [make
additional copies as necessary] of the application by explaining the nature of the
bankruptcy. If a judgment was entered, please supply documentation proving all
sanctions have been served and satisfied, or if not, stating the current status of
any proceedings.
5. (e) If you answer “yes” to this question, you must complete Section VI [make
additional copies as necessary] of the application by explaining the nature of the
case and the allegations made against the entity you were affiliated with. If a
judgment was entered against the entity, please supply documentation proving
all sanctions have been served and satisfied, or if not, stating the current status
of any proceedings.
ii. Question 2:
1. If you answer “yes” to this question, you must complete Section VI [make
additional copies as necessary] of the application by explaining the reason for
investigation or pending disciplinary action. You may be asked to supply copies
of documentation ordering the investigation or pending disciplinary action.
iii. Question 3:
1. If you answer “yes” to either 3(a) or 3(b) of this question, you must complete
Section VI and VII [make additional copies as necessary] of the application and
provide the information asked in the section.
DBPR ELC 3 Employee Leasing Company Group
2013 August
Incorporated by Rule: 61-35.013
5 of 32
e. Section V- Explanation(s) for Background Question 1(a)
i. Provide the information requested regarding the offense. Include supporting
documentation as requested in Section III.
f.
Section VI- Explanation(s) for Background Questions 1(b-e) and 2
i. Provide the information requested regarding the occurrence. Include supporting
documentation as requested in Section III.
g. Section VII- Explanation for Background Question 3
i. Provide the information requested regarding your insurance coverage.
h. Section VIII- Health Insurance Information
i. Provide the policy or contract number, name of carrier or service provider, effective
dates of coverage, and name and address of agent if you plan to offer health
insurance, including dental, to leased employees in the state of Florida.
ii. If you answered “yes” to Question 3 (a) or (b) in Section III this must be completed.
i.
Section IX- Workers’ Compensation, Unemployment Compensation, and Payroll Tax
Disclosure
i. Provide information as it relates to obligations for workers’ compensation. This includes
any amounts under dispute.
ii. Provide information about taxes paid to the State of Florida under the unemployment
tax account listed on page three (3) of the application.
j.
Section X- Affirmation by Written Declaration
i. The applicant must sign the affirmation by written declaration.
k. Section XI- Contract Provisions Checklist
i. This checklist is to assist in the drafting of the client service agreement which will be
used after licensure to engage in employee leasing with client companies.
ii. The contractual agreement must meet the requirements of Chapter 468 Part XI, F.S.
particularly Section 468.525(4), F.S.
l.
Section XII- Historical Sketch
i. This form must be completed by all individuals who directly or indirectly control a
specified percentage of voting stock, and/or are directors or principal officers of the
applicant or the ultimate parent.
ii. Provide the name, date of birth, Social Security number, and relationship to the
applicant.
iii. Provide the mailing address of the individual completing the historical sketch form.
iv. Provide a list of all business entities or organizations with which you are presently
affiliated.
v. If you answer “yes” to any of the background questions, you must provide a statement
of the charges and facts of the case, together with the name and location of the courts
in which the proceedings were held or are pending.
vi. Provide a list of each employer within the past four years.
vii. Provide the company name, type of business and address of the employer for which
employment is being provided.
viii. Provide the individual’s title and dates of employment.
-
m. Section XIII
Affirmation by Written Declaration for Historical Sketch
i.
The applicant must sign the affirmation by written declaration.
DBPR ELC 3 Employee Leasing Company Group
2013 August
Incorporated by Rule: 61-35.013