Oklahoma Employment Security Commission
                             Application for Oklahoma UI Tax Account Number                                                 OES-1  (7021- )
1. Business or Trade name                                                        Telephone No.           2. Federal Identification

3. Business mailing address (no. & St.)                               (City or Town)                     (State)            (Zip)

4. Type   of Organization:   Tribal Rated     Sole Proprietor    Partnership         Corporation     LLC             Ltd Partnership
                             Tribal Reim      Non-Profit Rated   Non-Profit Reim     Gov 1%          Gov Reim        Other (Specify)
5. Owners/Partners/Corp Officers/Members           Title         Residence Address            Telephone             Stock Ownership%
   Name-
   SSN#-
   Name-
   SSN#-
   Name-
   SSN#-
6. If a Corporation, or LLC Enter Full Name                                          State of Incorporation          Date of filing
                                                                                     or Filing
7. If an LLC how have you chosen to be taxed for federal tax purposes?               8. Email Address:
   Sole Proprietor         Partnership        Corporation
9. Is your Business a nonprofit organization? Yes             No      Do you have a 501(c)(3) exemption? Attach Copy. Yes           No
10. Date entered business in Oklahoma:        11. Date of first employment in Oklahoma:       12. Date of first payroll in Oklahoma:

13. Describe the exact nature of your business or employment activity and list the principal products
   manufactured or traded in Oklahoma:
14. Did you acquire an established business in Oklahoma?         Yes  No
   If Yes, did you acquire substantially all of the Oklahoma trade, organization, employees, business or assets?        Yes No
   See O.S. 40 3-111 and 3-111.1                     Date of acquisition:_____________________________
   Name, Address and Oklahoma account number of former owner.
15. Are you liable under the Federal Unemployment Tax Act?        Yes        No        If Yes, enter year liable:
16. If you have previously filed reports to the Oklahoma Employment Security Commission list name and account number:

17. List addresses of all locations in Oklahoma:                 (1)
   (2)                                                           (3)
18. Enter gross Oklahoma payroll for the current and two prior calendar years:
             Calendar Year            1stQtr.                  2ndQtr.                 rd   .                    4thQtr.
*Required                                                                              3 Qtr
                                    $                    $                       $                          $
                                    $                    $                       $                          $
                                    $                    $                           $                      $
19. Enter by week the number of workers you employed in Oklahoma during the same period.
        1st  2nd         3rd 4th          5th        1st         2nd  3rd        4th   5th             1st       2nd    3rd 4th       5th
Yr___   wk.  wk.         wk. wk.          wk. Yr___  wk.         wk.  wk.        wk.   wk.       Yr___ wk.       wk.    wk. wk.       wk.
Jan.                                          Jan.                                               Jan.
Feb.                                          Feb.                                               Feb.
Mar.                                          Mar.                                               Mar.
Apr.                                          Apr.                                               Apr.
May                                           May                                                May
Jun.                                          Jun.                                               Jun.
Jul.                                          Jul.                                               Jul.
Aug.                                          Aug.                                               Aug.
Sep.                                          Sep.                                               Sep.
Oct.                                          Oct.                                               Oct.
Nov.                                          Nov.                                               Nov.
Dec.                                          Dec.                                               Dec.
Note: Must be signed by owner, all partners, corporate officers or authorized official.
20. Signed:_____________________________________ Title __________________________________Date_____________________
                                                 For Commission use only                      Control No.
State No                                                         FEIN
L-Date                E-Date                  S-Date                  R-Date
L-Code                       Pred No                                                                 
                           Auxiliary Aids and Services are available upon request to individuals with disabilities

Instructions for preparation of form OES-1, Application for Oklahoma UI Tax Account Number

1.  Enter the name by which the business is known.  Examples:  “A & B Hardware”, Whiteway Theater, McDonalds, O Reilly’ s,   ’
     Starbucks, etc.  List your business telephone number.

2.   Enter Your Federal Identification Account Number.

3.   Enter address to which forms for reports, notices and correspondence should be mailed by Commission.

4.   Enter a check mark after the word that properly describes type of ownership of your business.

5.   Enter full name, residence address, telephone number andSocial Security Number of  all       owners,  
      partners, corporate officers or members.  Attach additional sheet if sufficient space is not provided.    
      All corporate officers, including officers of Sub-Chapter S corporations, are considered employees for 
      unemployment tax reports.  

6.   Enter full corporate name (as it appears on your corporate seal), date of incorporation or filing and State  
      which incorporated.

7.   When you reported to the U.S. Internal Revenue Service that you were chartering a limited liability 
      company, you were required to “check the box ”on IRS Form 8832 to inform them how you wanted to be taxed.  
      Your answer here should be the same as you selected for federal tax purposes.

8.   Enter the email address you want contacted for your business.

9.   If your answer is “Yes”, please attach a copy of your letter of exemption from the Internal Revenue Service.

10. Date your firm entered business in Oklahoma.

11. Enter the earliest date on which services were performed in Oklahoma.

12. Enter the date first payroll was issued for services performed in Oklahoma.

13. State what kind of business you operate in Oklahoma and the principal product manufactured or traded.

14. If your answer was “Yes”, please enter name and address of former owner and date acquired.

15. If “Yes”, enter the year you first became liable.

16. Self explanatory.
 
17. List addresses of all locations in Oklahoma where services are performed.  If the physical location of your business is out of state, you 
     must still list the Oklahoma address where services are performed even if they are performed by home-based employees. Attach additional 
     sheet if necessary.

18.  Enter gross payroll of your business by quarter for the current year and the preceding two (2) calendar 
       years (Oklahoma payroll only).

19.  Enter by week the number of workers to whom you furnished employment in Oklahoma.  Include both   
       full-time and part-time employees.  Indicate current calendar year employment followed by employment 
       in preceding calendar years.  A week is seven (7) consecutive calendar days beginning at 12:01 A.M. 
       Sunday and ending at 12:00 midnight on the next succeeding Saturday.

20.  Must be signed by owner, partner, corporate officer or authorized official.

Mail completed and signed form to:                    Oklahoma Employment Security Commission
                                                      Attn:  Employer Compliance
                                                      PO Box 52003
                                                      Oklahoma City OK  73152-2003
                                                      (405)557-5330; fax (405)557-7271