Alaska Employer Registration Form – Fill Out and Use This PDF

Alaska Department of Labor and Workforce Development

Division of Employment and Training Services

Employment Security Tax

Alaska Employer

Registration Form

WHO IS REQUIRED TO REGISTER?

Any person, firm, corporation, or other type of organization for some portion of a

day has employed one or more persons is required by law to register.

TO REGISTER ONLINE:

Go to https://my.alaska.gov. Create a myAlaska account or login.

Select the Services tab.

Under Services for Businesses, select Employment Security Tax.

Under Employer Maintenance, select New Registration.

		FOR ASSISTANCE	SEND COMPLETED
		CONTACT:	REGISTRATION FORM TO:
		In Juneau: (907) 465-2757	 Fax: (907) 465-2374
	 Toll-free outside Juneau:		 Email: esd.tax@alaska.gov
			Alaska Department of Labor
		(888) 448-3527
			and Workforce Development
		Relay Alaska:
			Employment Security Tax

(800) 770-8973	P.O. Box 115509
	Juneau, AK 99811-5509

We are an equal opportunity employer/program. Auxiliary aids and services

are available upon request to individuals with disabilities.

INSTRUCTIONS

Check the box on the top left of the form to indicate if this is a new or update registration.

UPDATE REGISTRATION INSTRUCTIONS

To update registration information, be sure to check the update box at the top left of the form in the Department of Labor and Workforce Development address block. Always complete #2, #3, #7 and #8, along with those items that have changed, or those boxes you have been instructed to complete.

Alaska Employer Registration Form

Account number

Bus. type

NAICS

Predecessor

Predecessor

Alaska Department of Labor

New

dues?

and Workforce Development

Update

Employment Security Tax

Field auditor

Mailings

Rate type

Rate year

Rate link

Rate

Receive date

type

P.O. Box 115509, Juneau, AK 99811-5509

COMPLETE BOTH SIDES OF FORM

THE ABOVE AREA IS FOR STATE USE ONLY

1) Type of business:

Sole proprietor

Partnership: General ________

Limited ________

Date partnership formed ________________________

Nonprofit organization

Federally recognized tribe

Other __________________________

Desired method of payment

Taxable

Reimbursable

Corporation: Date incorporated ___________________

State incorporated _____________________

State corporation number _____________________

Limited Liability Company (LLC) : Date formed _____________ State ____________

2) Federal Identification Number:

3) Have you ever been assigned an account number with

4) Do you wish to cover employees that can be excluded?

Employment Security Tax?

(See Page 3)

Yes

No

Yes

No

If yes, list number:

__________________

5) What is the date of your first payroll in Alaska or the anticipated date?

6)

Number of employees

Month ____________

Day ____________ Year ____________

(Your account will be opened this date)

in Alaska:

7) Legal business name:

8) DBA name:

9) Mailing address:

City:

State:

Zip:

10)

Business phone:

11) Physical worksite address in Alaska (list additional worksites below):

City:

Zip:

12)

Fax number:

13) Business contact name:

14) Business contact phone number:

15) Business contact email:

16) Business website:

17) Describe products and services your business provides in Alaska. (Failure to complete this section may result in

18) Of the items in #17, which

a higher tax rate.)

generates the most income?

19) Do you anticipate using contract labor to

20) Was there a previous business operating at your location?

21) Did you obtain any employees from #20?

perform the activities stated in #17?

Yes

No

Yes

No

N/A

Yes

No

If yes, prior business name:

If yes, how many? ___________

Complete this section if you have changed your business or have acquired an Alaska business operation.

22) Date changed or acquired:

23) Date of first payroll under new ownership:

Month ___________ Day ___________

Year ____________

Month ____________ Day ____________ Year ____________

24) Type:

Change in entity (sole proprietorship to partnership, partnership to corporation, etc.)

Change in partner

25) What percent of the Alaska

operating assets were acquired?

Change in corporation stock transfer

Corporate charter change

Corporate officer change

___________%

Purchase

Lease

Foreclosure

Repossession

Other (Describe in detail on separate paper)

26) Prior owner(s) name(s), FEIN and DBA name:

27) Prior account number

28) Number of

(if known):

employees

acquired:

Additional Alaska Worksite

Name (DBA):

Mailing address:

City:

State:

Zip:

Business phone:

Physical address:

City:

State:

Zip:

Fax number:

Of the items in #17, which one generates the most income at this worksite?

Number of employees at this worksite:

Name (DBA):

Mailing address:

City:

State:

Zip:

Business phone:

Physical address:

City:

State:

Zip:

Fax number:

Of the items in #17, which one generates the most income at this worksite?

Number of employees at this worksite:

Page 1

Form TREG (Rev. 2/19)

Employer name:

Account No.:

Voluntary Election of Coverage for Excluded Employment

(All employees in a selected non-covered employment group are reportable.)

Check non-covered employment you wish to cover:

Service of executive officers of a corporation formed under AS 10.06.

An executive officer is one who (1) is specifically named in the bylaws, (2) serves at the pleasure of the board, and (3) is given and actually exercises authority and responsibility for the overall management of the corporation. Note: Wages of corporate officers not meeting the definition of an executive officer are

reportable.

Service performed by an individual in the employ of a son, daughter or spouse (sole proprietor only).

Service by a child under age 18 for a parent (sole proprietor only).

Service performed for a parent or legal guardian if the individual is under the age of 21 and a full-time student during eight of the last twelve months and intends to resume full-time student status within the next four months (sole proprietor only).

Service performed for a nonprofit, federally recognized tribe or governmental agency by a person receiving work relief or work training where the program is financed in whole or in part by funds from any federally recognized tribe or a federal, state, or political subdivision.

Service by a minister or member of a religious order of a church.

Other service performed for a church or association of churches, including elementary and secondary schools, but not including other organizations operated for non-religious purposes.

Service for a school, college, or university by an enrolled student who is regularly attending classes.

Service in agricultural labor where the employer either paid less than $20,000 in wages per quarter in current or preceding calendar year or employed fewer than 10 people.

Service of fishing boat crewmembers if fewer than 10 who are paid a percent of the proceeds of the sale of the catch.

Domestic service in a private home when wages paid are less than $1,000 per quarter in the current or preceding year.

Service selling or distributing newspapers on the street or house to house.

Elected or appointed public officials.

Service in the fields of insurance, real estate, or stock by a salesperson, solicitor or broker paid by commission and are not required to be covered by the Federal Unemployment Tax Act.

Service by a full-time student under the age of 22 in a work-study program taken for credit at a public or nonprofit institution which certified that the service is an integral part of the program.

Service performed by an individual in the exercise of duties as an officer of a federally recognized tribe.

Effective date of voluntary election of coverage:	/	/
Signature				Business phone
Print name and title				Email

This agreement, when approved, is binding for two complete calendar years; if the approval is not at the start of a calendar year it is binding for the remainder of that calendar year and two additional years. Coverage continues in effect on a yearly basis until a request to terminate is received by the Agency in writing before March 15 of the termination year. In the event the account becomes delinquent, the Agency reserves the right to cancel the voluntary election of coverage retroactive to the quarter a report and full payment were last received.

Self-employment is not covered, nor can coverage be elected.

Sole proprietors, partners and members of an LLC are considered self-employed.

Page 3

Form TREG (Rev. 2/19)