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In order to be able to resume this form later, please enter your email and choose a password.

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Let's get to know your company!

We recognize that data collection may not be the most thrilling task, but it's crucial for crafting a personalized proposal that fits your needs perfectly! So, let's jump right in and kickstart the process!

Completing this form should take approximately 45 minutes, and you can save your progress and come back to it whenever you like. The form is divided into three sections for your convenience.

Section 1: Company Profile - 15 minutes
Section 2: Workers Compensation Review - 15 minutes
Section 3: Benefits Review - 15 minutes

Who is completing this form?

Name

Title

Please enter your personalized PIN provided by Tilson HR

Section 1: Company Profile

Organization Detail

Organization Legal Name

DBA

FEIN

Years in business

Street Address

City, State, Zip

SIC Code

Lookup: https://siccode.com/sic-code-lookup-directory

NAICS

Lookup: https://www.naics.com/code-search/

Please list any owners and their percentage of ownership

Payroll

Estimated Gross Yearly Payroll

Document Upload

Employee Census

Download Template Here.

State Unemployment Rate

Employers can find their State Unemployment Insurance (SUI) rate by visiting their state’s unemployment insurance agency website or logging into their account with the agency. Each state sets its own SUI rates and provides access to this information through their specific portal. Typically, employers also receive this information in a yearly notice from their state’s Department of Labor.

Are you currently with a PEO?

Yes

State Unemployment Rates

Please upload a snapshot of your state agencies website or the notice from the DOL. If you have any questions, please reach out to Blair Mulzer at bmulzer@tilsonhr.com

DWD Letter of Clearance

If you have any employees in Indiana, please upload your DWD Letter of Clearance. Instructions: Log into your DWD Employer Self Service Account at https://uplink.in.gov/ESS/ESSLogon.htm Select “Request” then “Request Clearance Certificate”. Then the system will then issue the certificate if there is not a balance on the account.

Save my progress and resume later | Resume a previously saved form

Section 1: Company Profile

Section 2: Workers Compensation Review

Section 3: Benefits Review