Form LWC-ES 1 Employer Application for La Unemployment Account - Louisiana

Form LWC-ES1 or the "Employer Application For La Unemployment Account" is a form issued by the Loisiana Workforce Commission.

Download a fillable PDF version of the Form LWC-ES1 down below or find it on the Loisiana Workforce Commission Forms website.

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LOUISIANA WORKFORCE COMMISSION
PHONE (225) 342-2944
EMPLOYER APPLICATION
U.I. Tax Liability and Adjudication
FAX
(225) 342-1943
for
P.O. Box 94186
FOR OFFICAL USE ONLY
LA UNEMPLOYMENT ACCOUNT
Baton Rouge, LA 70804-9186
ACCOUNT NO.
www.LWC.LA.gov
PLEASE REVIEW THE INSTRUCTIONS ON THE NEXT PAGE BEFORE COMPLETING THIS FORM
1. EMPLOYER or CORPORATION NAME
2. LA WITHHOLDING NUMBER
(Legal name is mandatory)
3. TRADE NAME or DBA NAME
4. FEDERAL EMP. I.D. NUMBER
5. MAILING ADDRESS (P.O. BOX OR STREET)
CITY
STATE
ZIP CODE
6. FAX NUMBER
7. PHYSICAL LOCATION IN LOUISIANA
(STREET)
CITY
STATE
ZIP CODE
8. TEL. NO. & EXT. (PHYSICAL LOCATION)
– mandatory
9. NAME OF CONTACT PERSON WITH PAYROLL RECORDS
10. TEL. NO. & EXT. (PAYROLL)
11. NAME AND ACCOUNT NUMBER OF PREVIOUS OR EXISTING LOUISIANA ACCOUNTS (Attach separate sheet if necessary)
12. E-MAIL ADDRESS
13. Type of Organization:
_______
Individual
Partnership
LLC
LLP
Corporation:
State
Date ___________________
Other
.
Government: Local
State
Funding type: General Appropriations
Self Generated
Mixed Funds
.
14A. Do you have a contract with a Professional Employer Organization (PEO)?
YES
NO
If “YES,” complete the information on the line below.
____________________________________________________________
_____________
____________
PEO Name:
Fed ID:
Contract Date:
14B. Are you a Professional Employer Organization?
YES
NO
If “YES,” provide a list of all clients with Fed. ID and UI numbers for each.
Use a separate sheet if necessary.
Note: If a bonded PEO, you will receive a mandatory quarterly Multiple Worksite Report to provide employment and wage breakouts for each client.
15. LIST BELOW THE OWNER OF SOLE PROPRIETORSHIP, ALL PARTNERS IN PARTNERSHIP, OR ALL OFFICERS OF CORPORATION. (Attach a separate sheet if necessary.)
NAME AND TITLE
SOC. SEC. NO.
RESIDENCE
TELEPHONE & EXT.
16. (A) REGULAR EMPLOYERS:
_____
_____
Did you or will you have total wages in a calendar quarter equal to or greater than $1,500?
YES
NO
If “YES,” Quarter
and Year
Did you or will you employ 1 or more employees in 20 weeks or more in a calendar year?
If “YES,” date of the 20th week.
YES
NO
_____
_____
_____
Month
Day
Year
(B) AGRICULTURAL EMPLOYERS:
If “YES,” date of the 20th week.
_____
_____
_____
Did you or will you employ 10 or more employees in 20 weeks or more in a calendar year?
Month
Day
Year
YES
NO
_____
_____
Did you or will you have total wages in a calendar quarter equal to or greater than $20,000?
YES
NO
If “YES,” Quarter
and Year
_____
Domestic employers must elect to file
or
(C) DOMESTIC EMPLOYERS (i.e., household help, sitter, nanny, etc.):
Annually
Quarterly _______
_____
Did you or will you have total wages in a calendar quarter equal to or greater than $1,000?
YES
NO
If “YES,” Quarter
and Year
_______
(D) NON-PROFIT EMPLOYERS:
Do you have a 501(c)(3) exemption from the Internal Revenue Service?
YES
NO
If “YES,” you must attach a copy of your IRS 501(c)(3) exemption letter and answer 17. If “NO,” answer 16A.
_____
Did you employ 4 or more employees in 20 weeks or more in a calendar year?
YES
NO
If “YES,” enter Month
Day _______ Year _______
Taxable
Reimbursable
17. LOCAL GOVERNMENT OR NON-PROFIT EMPLOYER:
Indicate the method you elect to pay taxes:
18. DATE ENTITY FIRST HAD EMPLOYEE(S) IN LOUISIANA: Month
Day
Year
# of employees:
18A.
19. ARE YOU APPLYING FOR A LETTER OF GOOD STANDING FOR LOTTERY PURPOSES ?
YES
NO
___
___
____
____
20. ARE YOU LIABLE UNDER THE FEDERAL UNEMPLOYMENT TAX ACT (FUTA)?
YES
NO
If “YES,” enter Month
Day
Year
State
21A. DID YOU ACQUIRE ANY OF THE ORGANIZATION, TRADE, BUSINESS,
B. IF YES, DID YOU ACQUIRE
C. IS THE BUSINESS ACQUIRED
OR ANY ASSETS OF ANOTHER LOUISIANA EMPLOYER OR HAD A
PART
ALL
STILL OPERATING IN LOUISIANA?
CHANGE IN YOUR FEDERAL ID#?
YES
NO
YES
NO
OF THE LOUISIANA OPERATION?
If a partial acquisition, you must complete an Application for Partial Transfer. If not, the Agency may perform an audit to determine the data transfer.
D. NAME OF ORGANIZATION ACQUIRED
E. THEIR LA UNEMP. INS. NO.
F. DATE ACQUIRED OR FED. ID# CHANGED
22. ADDITIONAL LOUISIANA ORGANIZATION ACQUIRED
A.
PART
ALL
C. THEIR LA UNEMP. INS. NO.
D. DATE ACQUIRED
B. STILL OPERATING:
YES
NO
23. IF YOU HAVE WORKERS PERFORMING SERVICES FOR YOUR BUSINESS WHO YOU CONSIDER TO BE INDEPENDENT CONTRACTORS, PLEASE READ #23 IN THE INSTRUCTIONS.
24. DESCRIBE YOUR BUSINESS ACTIVITY. THIS INFORMATION WILL DETERMINE YOUR U.I. TAX RATE. BE SPECIFIC!
List your main products or services in the space provided (i.e., full service restaurant, residential heating and air contractor, internet publisher). Manufacturers, provide the type of product and
materials used. If involved in more than one activity, provide approximate percentage of revenues or sales for each activity. Attach a separate sheet if additional space is needed.
Please provide us the name (print) and telephone number of the person who can supply additional information about your business activity.
_______________________________________________________________
__________________________________
Name
Telephone & Ext.
If employees work from home (i.e., sales representatives) in Louisiana, please give the Street, City, and Zip Code.
Street _______________________________________________________________ City _________________________________________________ Zip Code ______________
Signature and Title
Phone No.
Date
LWC-ES1web (REV. 12/2008)
ACCOUNT
LIAB DATE
QUAL DATE
LIAB CODE
REPT CODE
TOC
PART CODE
DATE
ANALYST

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