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
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
INSTRUCTIONS FOR EMPLOYER ACCOUNT APPLICATION
Do not submit this form until you can satisfy one of these requirements:
You meet one of the requirements in #16;
OR you answer “Yes” to #20 and have employees in Louisiana;
OR you answer “Yes” to Number #21A;
OR you are a local or state government employer.
1.
Enter the legal employer name or full corporation name as it appears on your corporate seal. Do not use abbreviations unless the legal name
uses the same abbreviations.
2.
Enter your Louisiana Withholding Number (Louisiana Revenue Number).
3.
Enter the name by which the business is known or the “Doing Business As” (DBA) name.
4.
Enter your Federal Employer’s Identification Number (FEIN/FUTA). A change in Federal ID Number alone requires completion of a new
Employer Account Application.
5.
Enter the mailing address to which reports, notices, and correspondence should be mailed by this Agency.
6.
Enter your fax number if available.
7.
Enter the actual location of your business in Louisiana. This must be a Louisiana address. For employees who work out of their homes, this is
needed for coding purposes only; nothing is mailed to this address.
8.
Enter the telephone number and extension of your physical location.
9.
Enter the name of the person or company that prepares your payroll records or has knowledge of such records.
10. Enter the telephone number and extension of the person or company listed in #9.
11. Enter all LA Unemployment Insurance (UI) account numbers and names if you previously filed or currently file reports to LA.
12. Enter an e-mail address if available.
13. Check the box to the right of the word that describes the type of ownership. Louisiana will treat LLCs as a partnership unless IRS Form 8832 is
attached for election of treatment. Enter the state of incorporation and date of incorporation. If government, list whether local or state. If state
government, check whether funding is entirely from General Appropriations, Self-generated, or a mixture of General Appropriations and Self-
generated.
14A. If you are an employer who has a contract with a Professional Employer Organization (PEO), provide the PEO’s name, PEO’s Federal ID#, and
the date of your PEO contract. Note: Employers may be liable for unpaid taxes of the PEO.
14B. If you are a PEO completing this Employer Account Application, provide a list of all your clients with the Federal ID# and State UI# of each. Use
a separate sheet if necessary.
15. List the full name and title, Social Security Number, residence address, and telephone number and extension of all owners, partners, or officers
of the corporation. Attach a separate sheet if necessary.
16. Check A, B, C, or D. If you are a domestic employer, you must file either quarterly or annually. If you are a non-profit employer, you must
attach your 501(c)(3) exemption and answer #17. If you do not have a 501(c)(3), you will be treated as a regular employer; answer #16A.
When you receive the 501(c)(3), submit it to the Agency for consideration on non-profit status. If approved, you will be granted non-profit status
effective as of the IRS’s approval of such status.
17. If you are a local government or non-profit employer, indicate the method you elect to pay taxes:
Taxable: employer pays taxes on wages paid to employees at a computed tax rate.
Reimbursable: employer pays the actual cost of benefits paid to former employees.
18. Enter the month, day, and year you first had employees who were paid wages in Louisiana.
18A. Enter the number of employees employed when your entity first began in Louisiana.
19. Answer “Yes” or “No” if you are a Lottery Retailer.
20. If “Yes,” enter the date and state you first became liable to FUTA.
21A. Assets are employees, operations, property, trade name, etc. If “Yes,” you must answer B, C, D, E, and F. If you had a change in entity (eg.,
individual to corp., corp. to LLC, etc.) with a Federal ID# change, this section applies to you.
21B. If a partial acquisition, the Application and Agreement for Partial Transfer must be submitted within 180 days of the acquisition. If
not, the Agency may perform an audit to determine the experience rating data to be transferred.
22. Did you acquire more than one LA operation? If “Yes,” answer A, B, C, and D. Use a separate sheet if necessary.
23. If you have workers who you consider to be self-employed or independent contractors, please review the following to be sure you are in
compliance with the law. Louisiana Employment Security Law provides that services performed by an individual for wages or under any contract of
hire shall be deemed to be taxable employment unless and until it is shown that: 1. Such individual has been and will continue to be free from any
control or direction over the performance of such services both under his contract and in fact, and 2. Such service is either outside the usual course
of the business for which such service is performed, or that such service is performed outside of all the places of business of the enterprise for which
such service is performed, and 3. Such individual is customarily engaged in an independently established trade, occupation, profession, or business.
24. Be specific when describing your business; provide the name and phone number of the contact person for additional information. If your
business is made up of more than one establishment in LOUISIANA, please attach a separate sheet and list the physical location and employment
count of each location.
Sign your name and list title, phone number and extension, and the date.
Mail or fax this Employer Account Application form and any attachments to the address or fax number on the first page of this form.
LWC-ES1/WEB (Rev 12/2008)

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

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