Texas Vtdlr Form Sls 017 – Fill Out and Use This PDF

13. Working Capital Requirements

Pursuant to House Bill 2249 (81st Legislature, 2009) effective December 31, 2011, all Staff Leasing Services companies must submit an audited financial statement that shows positive working capital. Please enclose your most recent audited financial statement with this application.

“Working capital” of an applicant means the applicant’s current assets minus the applicant’s current liabilities as determined by generally accepted accounting principles. An applicant for an original or renewal license must demonstrate positive working capital in the following amounts:

(1)$50,000 if the applicant employs fewer than 250 assigned employees;

(2)$75,000 if the applicant employs at least 250 but not more than 750 assigned employees; and

(3)$100,000 if the applicant employs more than 750 assigned employees.

The audited financial statement must be prepared in accordance with generally accepted accounting principles, be audited by an independent certified public accountant, and be without qualification as to the going concern status of the applicant.

Please note: surety bonds, letters of credit, or guarantees ALONE are no longer accepted as proof of positive working capital. You MUST submit an audited financial statement for the company named on this application. Any deficiencies in the working capital requirement may be satisfied through guarantees, letters of credit, a surety bond or other security acceptable to TDLR, provided they are accompanied by the company’s audited financial statement. For more information on working capital requirements, please see our website: www.license.state.tx.us/sls/sls.htm or call us at (800) 803-9202.

14. Controlling Persons and/or Corporations

FORMS ARE AVAILABLE AT OUR WEBSITE: www.license.state.tx.us/sls/slsforms.htm

Please submit a Controlling Person Personal Information Form for each Controlling Person of your company.

Please submit a Controlling Corporation Information Form, if applicable.

15. Additional Attachments & Information

WORKER’S COMPENSATION CERTIFICATE OF INSURANCE: Please enclose a certificate of insurance if you offer worker’s comp insurance to employees assigned in Texas. Insurers must be authorized by Texas Dept. of Insurance. INSURANCE INFORMATION FORM: Please complete the enclosed Insurance Information Form (page 3) for all other types of insurance offered to employees assigned in Texas, if applicable. Do not submit certificates or booklets for other types of insurance (health, disability, life, etc.).

DESIGNATED AGENT FOR SERVICE: Please provide the following information for your agent for service in Texas:

________________________________________________________________(________)__________ - ___________

16. Authorized Signature

I certify that I have read the Staff Leasing Services Act, Title 2, Labor Code, Subtitle E, and the current Department of Licensing and Regulation rules. If the license is issued, I agree to furnish to the Department of Licensing and Regulation any change in information on this form and all attached documents within FORTY-FIVE (45) DAYS of the change.

Licensure is subject to revocation if the department is not notified, in writing, of any changes in the information given on this application or if there is a rule or law violation.

I certify that all information submitted on this application and on all attached documents is true and correct.

__________________________________________________________________________________________________________

Authorized Representative’s SignatureDate

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