Fillable EMPLOYER REPRESENTATIVE AUTHORIZATION (ADP)

Fill Online, Printable, Fillable, Blank EMPLOYER REPRESENTATIVE AUTHORIZATION (ADP) Form

Use Fill to complete blank online ADP pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

EMPLOYER REPRESENTATIVE AUTHORIZATION (ADP)

On average this form takes 5 minutes to complete

The EMPLOYER REPRESENTATIVE AUTHORIZATION (ADP) form is 1 page long and contains:

  • 0 signatures
  • 6 check-boxes
  • 17 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your ADP forms online.

BROWSE ADP FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Employer Serial Number: ______________________
Employer: ___________________________________________________________________________
___________________
________
Physical address of business in KANSAS. If no physical address, store front or business location exists in KANSAS, you must indicate
where in KANSAS you have workers performing a service. Do NOTXVHD3RVW2I¿FH%R[QXPEHU
%XVLQHVVORFDWLRQ-REVLWH&RPSDQ\UHSUHVHQWDWLYHUHVLGHQFH
Other (
explain): _______________________________________________________________________________________
______________________________________________________________________________________________________________
Address (Do NOT use PO Box number) &LW\6WDWH=,3
Representative retained to represent you: ______________________________________________________
__________________
_____
Representative’s phone: __________________________________ Representative’s email: _____________________________________
Indicate which Kansas unemployment insurance reports you have delegated the authority to receive. Provide the mailing address for the
delegated reports.
Employer’s Quarterly Wage Report and Unemployment Tax Return, K-CNS 100
Name: ___________________________________________________________________________________________________
Address: __________________________________________________________________________________________________
&LW\6WDWH=,3BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
Annual Experience Rating Notice, K-CNS 404, and $QQXDO1RWLFHRI%HQH¿W&KDUJHV, K-CNS 403
Name: ___________________________________________________________________________________________________
Address: __________________________________________________________________________________________________
&LW\6WDWH=,3BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
/DVW(PSOR\HU%DVH3HULRGDQGDOORWKHU%HQH¿WDQG$SSHDO&ODLP1RWLFHV
Name: ___________________________________________________________________________________________________
Address: _________________________________________________________________________________________________
&LW\ 6WDWH =,3 BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
_________________________________________________________________________________ ___________________
________
__
2ZQHUSDUWQHUFRUSRUDWHRI¿FHU//&PHPEHUPDQDJHUVLJQDWXUH 'DWHPPGG\\\\
___________________________________________________________ __________________________________________________
Email Phone
0RUHLQIRUPDWLRQDERXW¿OLQJUHSRUWVDVDQDXWKRUL]HGHPSOR\HUUHSUHVHQWDWLYHLVIRXQGDWwww.KansasEmployer.gov.
EMPLOYER REPRESENTATIVE AUTHORIZATION
.&165HY
.$16$6'(3$570(172)/$%25
www.dol.ks.gov
.DQVDV'HSDUWPHQWRI/DERU
8,7D[&RQWULEXWLRQV
6:7RSHND%OYG
7RSHND.6

81(03/2<0(177$;&2175,%87,216
6:7RSHND%OYG7RSHND.63KRQH)D[.'2/8,7D[#NVJRY

Request will be denied if any item is incomplete.

Clear Form
PRINT
SAVE
ADP, LLC, and its subsidiaries and Corporate Cost Control, LLC.
The parties may be addressed collectively as ADP NEW HAMPSHIRE.
855 537-8435
UIDOCS@ADPUNEMPLOYMENTCLAIMS.COM
ADP UNEMPLOYMENT CLAIMS
PO BOX 1390
LONDONDERRY NH 03053-1390
ADP UNEMPLOYMENT CLAIMS
PO BOX 1390
LONDONDERRY NH 03053-1390
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

EMPLOYER REPRESENTATIVE AUTHORIZATION (ADP)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 8 February 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document