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Alabama Department of Labor

Professional Employer Organization - Affidavit of Temporary Help Service Agency
Temporary Help Service Agency Information:
Tell us more about your
Temporary Help Service Agency:
Name of
Temporary Help Service Agency
  
Please enter the full name of the Temporary Help Service Agency.

Unemployment Compensation Account #

Please only numbers for the ten digit UC Account Number. No hyphens.

First Name

Please enter the first name of the primary contact person.

Middle Initial

Please enter the your middle initial of the primary contact person.

Last Name

Please enter the your last name of the primary contact person.

Title / Position

Please enter the current title / position of of the primary contact person at the Temporary Help Service Agency.

Business Address:

   		Please enter the address were the Temporary Help Service Agency is located.

City:

   		Please enter the city in which the Temporary Help Service Agency is located.

State:

Please enter the state in which the Temporary Help Service Agency is located.

Zip

Please enter a U.S. Postal zip code.

Telephone

Please enter the telephone number as
( XXX) XXX-XXXX.

Fax

Please enter the Fax number as
( XXX) XXX-XXXX.

E-Mail Address:

Please enter email as "yourname@isp.com".