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Work Sharing (WS) Unemployment Insurance Plan Application DE 8686 - California
| Work Sharing (WS) Unemployment Insurance Plan Application Form. This is a California form and can be used in EDD Forms Workers Comp . |
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WORK SHARING (WS) UNEMPLOYMENT INSURANCE PLAN APPLICATION 1. Enter the following information as shown on the most recent DE 3DP/DE 9423, Quarterly Returns: Employer Name: Mailing Address: California Employer Account Number (Eight Digits): Telephone Number: ( ) 2. Enter specific type of business: 3. Enter the employer name that will be used on WS Certifications: 4. Location(s) where WS will occur, if different from Section 1: Employer Name: Address: Telephone Number: ( ) Employer Name: Address: Telephone Number: ( ) 5. Is your business/organization a public entity? R Yes R No If Yes, please enter an "X" in the box next to the type of public entity that best describes your organization: R City R County R State R Federal R School District R Other (Specify) 6. Enter effective date of WS Plan (New or Renewal): / / Note: The earliest effective date for a new WS Plan is the Sunday prior to the "first contact date" shown below in the "FOR EDD USE ONLY" box. The effective date for a renewed WS Plan is the day after the prior plan expires, providing the plan application is submitted no more than 10 days after the prior plan has expired. A. If you are renewing your plan, how many additional Work Sharing Certifications, (DE 4581WS), do you need? 7. If you are adding employee(s) or work unit(s) to your existing plan, enter the effective date of the expanded coverage. / / Note: The effective date is the Sunday prior to the date the expanded coverage will occur. FOR EDD USE ONLY First Contact Date / / EFF. Date / / R New WS Plan WS EE: %: SIC: R Renewal R Expanded WS Coverage Union (Y or N) Status (T or P) DE 8686 Rev. 15 (2-06) (INTERNET) Page 1 of 5 CU American LegalNet, Inc. www.USCourtForms.com 8. Enter the estimated weekly percentage reduction in hours and wages of employees participating in the WS Plan: 9. Please fill in the blanks (use additional paper if necessary): A. Work Unit(s) participating in WS 1. 2. 3. B. Number of employees in unit(s) 1. 2. 3. TOTAL: 10. Please enter an "X" in the box next to the appropriate response: A. Payroll periods are: % C. Number of employees participating in WS 1. 2. 3. TOTAL: R Weekly R Bi-Weekly R Monthly R Other (Specify) B. If pay periods are weekly or bi-weekly, the payroll ending day is: R Mon R Tues R Wed R Thur R Fri R Sat R Sun 11. Is this WS Plan part of a transition to a permanent layoff or closure? R Yes R No 12. Briefly describe the circumstances requiring your use of the WS program to avoid layoffs: 13. Are any participating employees covered by a union/collective bargaining agreement? R Yes R No (If Yes, page 5 must be completed) 14. Your participation in the Work Sharing program is confidential. Occasionally the Employment Development Department receives requests for the names of companies that would be willing to share their experiences in this program. Are you willing to have your name released for this purpose? R Yes R No 15. Please answer the following: Does your WS Plan involve: A. At least two employees? B. At least 10% of your workforce or work unit(s)? C. At least a 10% reduction in BOTH hours worked and wages? R R R Yes Yes Yes R R R No No No THANK YOU FOR CHOOSING WORK SHARING! DE 8686 Rev. 15 (2-06) (INTERNET) Page 2 of 5 CU American LegalNet, Inc. www.USCourtForms.com WORK SHARING EMPLOYER'S HOLIDAY SCHEDULE This schedule is a required part of the Work Sharing Unemployment Insurance Plan Application This information is necessary to process your employees' Work Sharing (WS) payments. Work Sharing regulations state that a holiday cannot be used as a WS day unless an employee in the same position performed compensated services as part of an employee's regular paid work week during the 12 months prior to the employer's participation in the WS Program. Indicate whether your company was open or closed due to holidays on the days listed below during the 12 months prior to the effective date of your WS Unemployment Insurance Plan Application. For example, if your WS Unemployment Insurance Plan is effective in January 2003, the 12 month period would be January 2002 through December 2002. HOLIDAY New Year's Eve New Year's Day Martin Luther King Jr. Day Lincoln's Birthday Washington's Birthday President's Day Cesar Chavez Good Friday Memorial Day July 4 th OPEN CLOSED COMMENTS Labor Day Columbus Day Veteran's Day Thanksgiving Day After Thanksgiving Christmas Eve Christmas Other Holidays: Please list below Please print or type the following information: Date: ____/____/____ Employer Name: California Employer Account Number (Eight Digits): ___ ___ ___ -- ___ ___ ___ ___ - ___ Contact Person: Position or Title: DE 8686 Rev. 15 (2-06) (INTERNET) Page 3 of 5 CU American LegalNet, Inc. www.USCourtForms.com CERTIFYING INFORMATION 1. We understand that if we are a participating employer using the tax rate method, our reserve account will be charged in the usual manner for benefits paid under this program. In addition, these charges may increase the employer's unemployment insurance contribution rate in future years. 2. We understand that if you are a participating reimbursable employer, we will be billed quarterly for the cost of benefits paid in the same manner as they are currently billed for other unemployment insurance benefits. 3. We understand that a holiday cannot be used as a Work Sharing day unless the employee(s), in the same position, performed compensated services as part of the employee(s) normal weekly hours of work on that holiday, during the twelve month period prior to the employer's participation in the Work Sharing program. Furthermore, we understand that we are not to issue certification forms to employees that contain a holiday as the only Work Sharing day. (Section 1279.5 of the California Unemployment Insurance Code). 4. We will provide the Employment Development Department with the weekly percent of reduction in hours and wages for each participating employee as a result of this Work Sharing program. 5. We understand that in order to be eligible, any employee must have worked at least one normal work week with no reductions prior to issuance of certification forms for benefit payment. 6. We understand that if any employee is working for a school district and/or non-profit entity providing services to a school district, we must provide the Employment Development Department with the dates individual employees are between successive academic terms and/or in a recess period. Furthermore, we understand that we are not to
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