Employer

All fields are required unless indicated as optional.

Employer Information
Provide the full legal name of the employer. SWEPs should enter the identifying information for the school that is applying for the certificate. {{ validate('employer.legalName') }}
Does the Employer have a Trade Name?
Provide the trade name of the employer, if applicable. {{ validate('employer.hasTradeName') }}
{{ validate('employer.tradeName') }}
Has the Employer’s name(s) changed since its last application?
Provide the previous name(s) of the employer, if applicable. {{ validate('employer.legalNameHasChanged') }}
{{ validate('employer.priorLegalName') }}

The EIN you provided is already registered. Please contact the account admin for access.

If you do not know the account admin, contact our office at 00-1234567

EIN is required.

Invalid EIN format. Example XX-XXXXXXX

 Example: 00-1234567
Physical Address of Employer’s Main Establishment
{{ validate('employer.physicalAddress.streetAddress') }}
{{ validate('employer.physicalAddress.city') }}
{{ validate('employer.physicalAddress.state') }}
{{ validate('employer.physicalAddress.zipCode') }}
{{ validate('employer.physicalAddress.county') }}
Mailing Address of Employer’s Main Establishment
{{ validate('employer.mailingAddress.streetAddress') }}
{{ validate('employer.mailingAddress.city') }}
{{ validate('employer.mailingAddress.state') }}
{{ validate('employer.mailingAddress.zipCode') }}
{{ validate('employer.mailingAddress.county') }}
Does the Employer have a Parent Organization?
If applying as a SWEP, select “Yes” and enter the school district’s information. {{ validate('employer.hasParentOrg') }}
Parent Organization Information
{{ validate('employer.parentLegalName') }}
{{ validate('employer.parentAddress.streetAddress') }}
{{ validate('employer.parentAddress.city') }}
{{ validate('employer.parentAddress.state') }}
{{ validate('employer.parentAddress.zipCode') }}
{{ validate('employer.parentAddress.county') }}
Employer Status
Select the option that describes the employer’s status. For example, a SWEP operated by a public school system should select “Public.” {{ validate('employer.employerStatusId') }}
{{ validate('employer.employerStatusOther') }}
Is this employer a local or State educational agency?
The term “local educational agency” means a public board of education or other public authority legally constituted within a State for either administrative control or direction of, or to perform a service function for, public elementary schools or secondary schools in a city, county, township, school district, or other political subdivision of a State, or of or for a combination of school districts or counties that is recognized in a State as an administrative agency for its public elementary schools or secondary schools. The term “State educational agency” means the agency primarily responsible for the State supervision of public elementary schools and secondary schools. See 20 U.S.C. 7801, the Elementary and Secondary Education Act of 1965. {{ validate('employer.isEducationalAgency') }}

Number of Workers With Disabilities
When did the Employer’s most recently completed fiscal quarter end?
Provide the ending date of the employer’s most recently completed three-month fiscal quarter. For example, if the fiscal year begins on January 1, provide the date of the most recently completed quarter (March 31, June 30, September 30, or December 31). {{ validate('employer.fiscalQuarterEndDate') }}
Include workers who were employed for less than the full fiscal quarter, i.e. three-month period. {{ validate('employer.numSubminimalWageWorkers.total') }}
Provide the number of workers with disabilities employed at subminimum wages for the most recently completed fiscal quarter in each of the following categories:
A facility that primarily provides vocational rehabilitation services and employment for people with disabilities. {{ validate('employer.numSubminimalWageWorkers.workCenter') }} If no workers, enter "0"
A facility (public or private, non-profit or for-profit) that primarily provides residential care for individuals with disabilities, including but not limited to nursing homes, intermediate care facilities, assisted living facilities, halfway houses, and residential substance abuse treatment facilities. “Primarily” means that more than 50 percent of the facility’s income is attributable to this residential care. A patient worker is a worker with a disability who is employed by a hospital or residential care facility (as defined above) where the patient worker receives inpatient or outpatient treatment or care. {{ validate('employer.numSubminimalWageWorkers.patientWorkers') }} If no workers, enter "0"
A school-operated program in which students with disabilities may be placed in jobs with private industry within the community. School employers are responsible for compliance with all applicable child labor laws, minimum wage standards, and certificate and recordkeeping requirements. The school may submit a group application which covers all students with disabilities and all of the business locations at which the students will be placed. {{ validate('employer.numSubminimalWageWorkers.swep') }} If no workers, enter "0"
Any employer other than a community rehabilitation program, hospital/residential care facility, or SWEP. {{ validate('employer.numSubminimalWageWorkers.businessEstablishment') }} If no workers, enter "0"

Government Contracts
Does this employer manufacture items for the Federal Government under the Walsh-Healey Public Contracts Act (PCA)?
Make the appropriate selection if the employer has, or intends to receive, any contracts with the Federal Government subject to the Walsh-Healey Public Contracts Act (PCA). Additional information about contracts with the Federal Government can be found at www.dol.gov/whd/govcontracts/. {{ validate('employer.pca') }}
Does this employer currently hold any contracts covered by the McNamara-O’Hara Service Contract Act (SCA)?
Make the appropriate selection if the employer has, or intends to receive, any contracts with the Federal Government subject to the McNamara-O’Hara Service Contract Act (SCA). Additional information about contracts with the Federal Government can be found at www.dol.gov/whd/govcontracts/. {{ validate('employer.scaId') }}
{{ validate('employer.scaCount') }}
{{ validate('employer.SCAAttachments') }}
Since January 1, 2015, has this employer entered into a contract for services or concessions with the Federal Government that may be subject to Executive Order 13658 (Establishing a Minimum Wage for Contractors)?
Make the appropriate selection if the employer has, or intends to receive, any contracts with the Federal Government subject to the Executive Order 13658, Establishing a Minimum Wage for Contractors. Section 14(c) workers performing on or in connection with a contract covered by Executive Order 13658 are generally entitled to be paid at least the Executive Order minimum wage. Additional information about contracts with the Federal Government can be found at www.dol.gov/whd/govcontracts/. {{ validate('employer.eo13658Id') }}

Additional Questions
Was the employer a representative payee for any worker with disabilities and, as such, received Social Security Benefits such as Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) on behalf of that employee during the most recently completed fiscal quarter?
{{ validate('employer.representativePayee') }}
{{ validate('employer.totalDisabledWorkers') }} If the employer was a representative payee for any worker with disabilities who received Social Security benefits during the most recently completed fiscal quarter, provide the total number of employees for whom the employer was the representative payee.
Did the employer take credit for the cost of providing facilities, such as board, lodging, and transportation, toward meeting the minimum wage or subminimum wage obligations to workers with disabilities during the most recently completed fiscal quarter?
Section 3(m) of the FLSA permits employers, under certain circumstances, to count toward its minimum wage obligations the reasonable cost of furnishing facilities which are customarily furnished to employees. Indicate if the employer provided facilities such as lodging, board, and transportation to any employee, and took credit for those costs toward meeting the minimum wage or subminimum wage obligations to employees with disabilities during the most recently completed fiscal quarter. See 29 C.F.R. § 531 and 29 C.F.R. § 516. {{ validate('employer.takeCreditForCosts') }}
Which type of deduction(s) did the employer take? {{ validate('employer.providingFacilitiesDeductionTypeId') }}
Is this a request for Temporary Authority by a vocational rehabilitation program administered by a State agency or the U.S. Veterans Administration?
Select "Yes" if this is a request for temporary authority to employ workers with disabilities at subminimum wages pursuant to a vocational rehabilitation program of the Veterans Administration for veterans with a service-incurred disability or a vocational rehabilitation program administered by a State agency. A copy of the signed application will constitute the temporary authority provided the application is submitted to the Department of Labor within ten days of the signing. Temporary authority will exist for 90 days from the date the application is signed and cannot be extended or renewed by the issuing agency. See 29 C.F.R. § 525.8. {{ validate('employer.temporaryAuthority') }}