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Rhode Island Department of Labor and Training TX-36 (Rev. 4/24)
EMPLOYER TAX DIVISION
1511 Pontiac Avenue, Cranston, RI 02920
Telephone: (401) 574-8700, option 1 | Fax: (401) 574-8940 | https://uitax.ri.gov
EMPLOYER'S ELECTION TO COVER MULTI-STATE WORKERS
under the RI Employment Security Law
Employer Name:_______________________________________ RI Registration Number: ______________
Business Address: _______________________________________________________________________
City/Town: ________________________________________State: _____ Zip: _______________
The above employer hereby elects, subject to approval by the unemployment compensation agencies involved, to cover
certain individuals customarily employment by them to work in more than one jurisdiction named below and on the
attached sheet under the Employment Security Law of Rhode Island.
1. The employer accordingly requests the Employer Tax unit to enter into a reciprocal coverage arrangement to that effect,
with each of the following other "interest jurisdictions" (in which the individuals named under Item 2 may do some work for
the employer, and under whose unemployment compensation laws they might otherwise be covered:
a.) _________ b.) _________ c.) _________ d.) _________ e.) _________
f.) _________ g.) _________ h.) _________ i.) _________ j.)_________
Submit 2 signed copies for each jurisdiction listed, plus 2 more and send all to the Employer Tax Unit at the address on
top of this form.
2. List of workers covered by this election:
Name: ______________________________________ SSN: ________________
Name: ______________________________________ SSN: ________________
Name: ______________________________________ SSN: ________________
3. Nature of employer's business: ____________________________________________________________________
4. The employer has a place of business in the following states: ____________________________________________
5. Nature of work to be performed by individual(s) listed: __________________________________________________
Basis for election in Rhode Island:
Does some work there Has residence there Related to a place of business there
6. Employer's reason for requesting coverage in Rhode Island: ____________________________________
______________________________________________________________________________________
7. Employer requests election become effective at the beginning of a calendar quarter, as of _____________________
8. This election, if approved, shall remain operative as to the individuals listed herewith until terminated in accordance with
the current applicable regulation of the RI Employer Tax section.
9. The employer hereby agrees to give each individual covered by this election a notice thereof, promptly after its approval
on this forms, to be supplied by the RI Employer Tax section and to file copies thereof with said agency.
10.To prevent this election from denying unemployment compensation coverage to workers not listed hereon, the employer
hereby agrees with each interested jurisdication approving this election that it may count the workers covered by this
election and their wages, as if this election did not apply, for the purpose of determining whether the employer is covered by
the law of such jurisdiction and whether any other workers employed by the employer are covered by said law.
An equal opportunity employer/program. Auxiliary aids and services are available upon request to individuals with disabilities. TTY Relay via 711
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