Colorado Department of Labor and Employment, Division of Unemployment Insurance, P.O. Box 8789, Denver, CO 80201-8789  
                        303-318-9100 (Denver-metro area) or 1-800-480-8299 (outside Denver-metro area), Fax 303-318-9214 
                                                               www.colorado.gov/cdle/ui 
                                                                          
                                                       POWER  OF  ATTORNEY 
                        Please print the information below.  Instructions for completing this form are provided on the reverse. 
Employer Information 
Employer Name                                                 Trade Name                                                                   Employer Account Number (Required) 
 
Business Location Address Only (No P.O. Box Number)           City                                                                         State ZIP Code
 
Acceptance of New Power of Attorney 
 
Effective Date of Acceptance _____________________________          
                                                                                                                                
Your acceptance of a new power of attorney supersedes any existing power of attorney previously approved by the Unemployment Insurance (UI) Division. 
Power of Attorney Complete Name and Address (No Abbreviations)                                                                  Telephone Number 
                                                                                                                                 
                                                                                                                                Email Address 

Complete Mailing Address For UI Premium Information and/or forms such as: Wages Paid and Premiums                               Telephone Number 
Owed, Billing Statements, and UI Rate Notice.                                                                                    
                                                                                                                                 
                                                                                                                                Email Address 
                                                                                                                                 
Complete only if the benefits mailing address is different from the premiums mailing address you provided above .
Complete Mailing Address For UI Benefits Information and/or forms such as: Requests for Job-Separation                          Telephone Number 
Information and Wages Reported and Possible Charges. 
 
                                                                                                                                Email Address 
 
Power-of- Attorney Signature 
 Print Name of the Power of Attorney Representative (Required)                                                                   Title 
                                                                                                                                  
 Power of Attorney Representative Signature (Required)                                                                           Date 
                                                                                                                                  
 Employer Approval 

 I hereby grant permission to the above-named entity or individual to act on my behalf for the purpose stated on this document. 
 Print Name of the Employer Official (Required)                                                                                  Title 
                                                                                                                                  
 Signature of Employer Official (Required)                                                                                       *Date 
                                                                                                                                  
   SIDES (To add employer account information to SIDES),   or go to:  http://info.uisides.org                                     
                                                                                                                                  
* Additional input must be received within 6-months from the date in the Employer Approval section. 
    
 Office Use Only                                                   Date                                                                     Q-Identification Number 
                                                                                                                                            
 Power of attorney is approved and input into the UI system.  
   
  UITL-18 (R 12/2014)                                                                                                           Clear Form       Save Form

     Colorado Department of Labor and Employment, Division of Unemployment Insurance, P.O. Box 8789, Denver, CO 80201-8789  
                              303-318-9100 (Denver-metro area) or 1-800-480-8299 (outside Denver-metro area) 
                                                                          
                              INSTRUCTIONS  FOR  COMPLETING  THE  POWER  OF  ATTORNEY 
                                                                          
                                                              Employer Information 
Employer Name:  Type or print legibly the entity name or business name. 
Trade Name:  Type or print legibly the doing-business-as name or trade name. 
Employer Account Number:  Type the 9-digit Colorado unemployment insurance (UI) premium account number.  The power of attorney will not be 
processed or approved if this account number is not provided. 
Business Location Address Only (No PO Boxes):  Type the entity’s or business's physical location address. 
 
                                                       Acceptance of New Power of Attorney 
Effective Date of Acceptance:  Complete this section if you want to name or change an entity or individual to have power of attorney.  If you complete 
this section, you must provide an effective date. 
SIDES:  State Information Data Exchange System.  By participating in this system, you will receive and respond to the electronic version of form UIB-
290, Colorado’s Request For Facts About A Former Employee’s Employment.  To find out more information about SIDES go to http://info.uisides.org.   It 
is strongly recommended that you participate in the SIDES system. 
For UI premium-related information:  Complete this section if you want to accept power of attorney for UI premium-related information only. 
For UI benefits-related information:  Complete this section if you want to accept power of attorney for UI benefit-related information only. 
Power of Attorney Complete Name and Address:  Type the name and address of the entity or individual you want to accept as the power of attorney.  
Do not list an individual’s name unless that is the business name. 
NOTE:  If you have an existing power of attorney and the UI Division approves your acceptance of a new power of attorney, the new power of attorney 
automatically replaces the existing power of attorney for the purposes you indicate on this form. 
 
                                                       Mailing-Address Information 
Complete Mailing Address:  For UI premium information and/or forms such as the UITR-7, Unemployment Insurance Rate Notice; UITR-1, Your 
Quarterly Report of Wages Paid and Premiums Owed; UITR-1a, Unemployment Insurance Report of Workers Wages; and UITR-2, Unemployment 
Insurance Statement of Payment Due; or any other premium forms you must provide the complete mailing address regardless of whether you are adding or 
changing a power of attorney.  This information must be completed to ensure that UI correspondence is sent to the address of the entity or individual who 
will be responsible for UI correspondence.  Provide a second mailing address only if you want the UI benefits-related information sent to a mailing address 
different from the mailing address used for premium-related information. 
NOTE:  You are responsible for ensuring that any UI correspondence that is sent to an incorrect mailing address is properly forwarded.  You are also 
responsible for updating your mailing address with us. 
 
                                                       Power-of-   Attorney Signature 
New Power of Attorney Representative Signature:  A representative of the entity or the individual who you want to accept as the power of attorney 
must provide his or her name and title and sign and date the form in order to make this a valid document. 
 
                                                              Employer Approval 
Signature of Employer Official:  The employer must sign this form to accept an entity or individual as the power of attorney.  The employer official’s 
name, title, signature, and date of signature are required to make this a valid document.   
 
                                                  Discontinuation of Power of Attorney 
If you elect to discontinue a power of attorney without accepting a new power of attorney, submit a written request to the UI Division at the above address. 

UITL-18 (R 12/2014)