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Department Use Only
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5. Has this business paid wages or paid other remuneration in lieu of wages such as dividends (“S” corporation only), bonuses, draws, or disbursements?
Yes No
NOTE: Wages include payments made to corporate officers performing any services in Colorado.
If Yes, provide the federal employer identification number (FEIN) if different than the FEIN provided in Item 4or the UI account number if different
than the account number provided in Item 2if applicable. ___________________________________________________________
6. Has this business paid any individual who is considered to be a contractor or subcontractor? Yes No
7. Has the business issued or does it intend to issue IRS Form 1099-MISC to any individual. Yes No
If Yes to Item 6or ,7describe the type of work performed_____________________
8. Is this business an employee-leasing company (i.e., does it lease employees to other businesses or management companies)? Yes No
9. Are the employees of this business hired through an employee-leasing company or management company? Yes No
If Yes: Provide the name of the employee-leasing or management company
Provide the FEIN and/or UI account number_______________________________________________________________
10. Is this business an individual/sole proprietor? Yes No
If Yes, are there any employees other than the individual, his or her spouse, or his or her children under the age of 21? Yes No
11. Is this business a partnership or limited liability organization? Yes No
If Yes, are there any employees other than the partners or members of the limited liability organization? Yes No
12. Select the item that best describes the business’s activity in Colorado (check only one box) and provide specific detail below. For additional information
regarding these industry descriptions, call Labor Market Information (LMI) at 303-318-8850 or contact LMI in writing at 633 17 thStreet, Suite 600, Denver,
CO 80202. Additional information is available online at lmigateway.coworkforce.com/lmigateway.
Agricultural (list crops, animals, and/or services provided) Construction—General Contractor
Mining (list product being mined and/or services performed) Residential
Utilities (list type and services performed) Single Family
Transportation, Communication, or Public Utilities (list type) Multiple Family
Retail Trade (list type of product sold and to whom) Commercial
Wholesale Trade (list type of product sold and to whom) Industrial/Warehouse
Service (list type and explain in detail) Other Commercial
Finance, Insurance, or Real Estate (list type and explain in detail) Speculative Builder/For Sale by Owner
Manufacturing and Assembly (list materials used and products rendered) Subcontractor (explain in detail)
Government (list type of agency) Heavy Construction
Household/Domestic Highway and Steel Construction
Other Bridge, Tunnel, and/or Elevated Highway
Water, Sewer, Pipeline, and/or Communication
Other Heavy Construction
Provide specific detail regarding the business’s activity in Colorado. If more than one service is provided, indicate which is predominant.
NOTE: If the business’s entire activity is seasonal or if it has seasonal occupations, a request for seasonal designation can be made by completing and
returning Form UITL-5, Request for Seasonal Determination. To obtain this form, go to www.colorado.gov/cdle/ui, click on Forms and Publications,
and then click on Employer Forms. If you have any questions regarding seasonal status, call us at one of the telephone numbers at the top of the initial
page of this application.
13. Worksite Information—Provide the following information for each physical location in Colorado. Do not provide P.O. boxes, payroll, or accountant
addresses. If an employee works from his or her home, you must provide the employee’s residence address. Attach additional sheets of paper for more than
one physical location in Colorado.
Complete Physical Street Address of Worksite (include city, state, and ZIP code)
Worksite Telephone Number Worksite Contact Person Average Number of Employees in a Typical Month
14. Business Acquisition—For purposes of this application, an acquisition is defined as the purchase or transfer of any or all of the assets and/or employees of
a previously established business. If this business entity was acquired, in accordance with CESA 8-76-104, we must make a determination regarding the purpose
of the business acquisition. If you have any questions regarding the acquisition of a business, call us at one of the telephone numbers at the top of the initial
page of this application. Enclose a copy of the sales agreement and a list of the board of directors for the new business and all acquired businesses.
Is the business entity completing this application as a result of a business acquisition? Yes No If No, skip to Item 17.
If Yes: Provide the date of acquisition
Check one of the boxes below to indicate the type of acquisition and complete Items 15 and 16.
Total Business Acquisition or Employee Transfer—This business acquired all of the organization, trade, or business or substantially
all of the assets of at least one employer or utilizes the services of 90 percent or more of the total number of employees from another
employer.
NOTE: This can include a reorganization of a current business.
Partial Business Acquisition or Employee Transfer—This business acquired some of the organization, trade, or business or assets of
at least one employer or utilizes the services of less than 90 percent of the total number of employees from another employer.
NOTE: This can include a reorganization of a current business.
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