Application For Worker Leasing Company License {2466}

2466 - WORKER LEASING LICENSE APPLICATION (INITIAL APPLICATION). This form is used to apply for an initial license to operate as a worker leasing company in the state of Oregon. It is submitted to the Workers’ Compensation Division of the Department of Consumer and Business Services. A business must complete this application to demonstrate that it meets the legal and regulatory requirements to provide worker leasing services under Oregon Administrative Rules (OAR) 436-180. The application collects detailed information about the applicant’s legal identity, business structure, operational contacts, history of compliance or violations, and the qualifications of any controlling persons involved in managing or directing the company. The form also requires supporting documentation, including tax compliance releases, safety and training procedures, and proof of relevant experience or licensure in other states. Additionally, the applicant must certify the accuracy of all submitted information under penalty of perjury and have it notarized. Once the application is reviewed and approved, a $2,050 licensing fee will be requested, and the license will be valid for two years, unless renewed. www.FormsWorkflow.com