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Department Use Only |
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15. Did the business entity acquire or hire any workers from the prior business who are now employed with the new business? |
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Yes |
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No |
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If Yes: How many employees were acquired? |
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How many employees did the prior business have during its last four pay periods? |
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Second-to-Last Pay Period |
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Third-to-Last Pay Period |
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Fourth-to-Last Pay Period_____________ |
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16. Provide the following information regarding the prior employer. |
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Prior Legal Business Name |
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Prior FEIN or UI Account Number |
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Name of Prior Owner |
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Current Telephone Number of Prior Owner |
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Complete Current Address of Prior Owner (include city, state, and ZIP code) |
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17.In accordance with the Colorado Employment Security Act (CESA), employers are required to provide UI coverage if one of the following conditions are met. Employers can meet these conditions through the employment of full-time, part-time, and temporary workers (including temporary agricultural workers with an H-2A visa).
NOTE: Calendar quarters are defined as January–March, April–June, July–September, and October–December.
Check the appropriate box and provide the corresponding information that is requested.
Commercial, Industrial, or Professional Organization (as defined in CESA 8-70-113)
Paid one or more workers a total of $1,500 in gross wages during any calendar quarter in the current or preceding calendar year Date on which you paid $1,500 in gross wages during a calendar quarter to meet this requirement
Employed one or more workers for some portion of a day in 20 different calendar weeks during the current or preceding calendar year (all 20 calendar weeks must occur within the same calendar year)
NOTE: The services do not have to be performed in consecutive weeks or by the same employee. Date on which you first employed a worker for some portion of a day to meet this requirement
Date on which you employed a worker for some portion of a day in the 20th calendar week to meet this requirement ______________________
Agricultural Employer (as defined in CESA 8-70-120)
Paid one or more agricultural workers a total of $20,000 in gross wages during any calendar quarter in the current or preceding calendar year Date on which you paid $20,000 in gross wages during a calendar quarter to meet this requirement
Employed ten or more workers for some portion of a day in 20 different calendar weeks during the current or preceding calendar year (all 20 calendar weeks must occur within the same calendar year)
NOTE: The services do not have to be performed in consecutive weeks or by the same ten employees. Date on which you first employed ten workers for some portion of a day to meet this requirement
Date on which you employed ten workers for some portion of a day in the 20th calendar week to meet this requirement _____________________
Household/Domestic-Services Employer (as defined in CESA 8-70-121)
Paid one or more workers performing domestic services in a private home, local college club, or local chapter of a fraternity or sorority a total of $1,000 in gross wages during any calendar quarter in the current or preceding calendar year
Date on which you paid one or more workers $1,000 in gross wages during a calendar quarter to meet this requirement _____________________
Nonprofit Organization, Including Political Subdivision (exempt under section 501(c)(3) of the Internal Revenue Code and as defined in CESA 8-70-118)
Political Subdivision/Government
Had four or more workers employed anywhere in the U.S. in any calendar quarter in the current calendar year or preceding calendar year NOTE: The services do not have to be performed in consecutive weeks or by the same four employees.
Date on which you first employed at least one worker in Colorado
Date on which you first employed four workers anywhere in the U.S. to meet this requirement
Date on which you employed four workers anywhere in the U.S. in the 20th calendar week to meet this requirement
Type of services provided ____________________________________________________________________________
18. Has the owner, partner, or corporate officer of this business entity owned or operated any business in Colorado or does the owner, partner, or corporate
officer currently own or operate any other business in Colorado? |
Yes |
No |
If Yes, provide the information requested below for each business regardless of whether it is still in operation or related to this business entity. In addition, provide the requested information for all affiliated businesses. Attach additional sheets of paper if necessary.
Legal Business Name |
UI Account Number |
FEIN |