STATE OF COUNTY OF ss AFFIDAVIT OF SELF EMPLOYMENT EXEMPTION UNDER THE WORKERS COMPENSATION ACT I Printed Name being first duly sworn upon oath deposes and states the following I am applying for a contractor s license for my company through the State of Arizona s Registrar of Contractors office. I am aware that as a condition of licensure that my company must comply with the Workers Compensation Act. I am self-employed* Therefore I am not an employer subject to the provisions of A. R*S* 23-902. I do not currently and will not in the future employ workers regularly employed in my business or trade under a contract for hire. as an employer. supervision or control that is done in the regular course of my business or trade. I may in my business use the services of an independent contractor to perform work done in the regular course of my business or trade. In the event that I use the services of an independent contractor such use shall be evidenced by a written agreement that the business ....
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How to fill out the AR RCL317A online
The AR RCL317A form is essential for individuals applying for a contractor's license in Arizona who wish to declare their self-employment status regarding workers' compensation. This guide will walk you through the steps necessary to complete the form online accurately and efficiently.
Follow the steps to successfully complete the form.
- Click the ‘Get Form’ button to obtain the form and open it in the editor.
- Begin filling out the form by entering your printed name in the designated field at the top of the document.
- Provide information in the first statement indicating that you are applying for a contractor's license through the relevant office in Arizona.
- Confirm your awareness of the requirement to comply with the Workers’ Compensation Act as a condition of licensure.
- Indicate your self-employment status in the appropriate section, affirming that you are not an employer according to A.R.S. § 23-902.
- Clearly state that you do not employ workers regularly in your business or trade, as detailed in the next sections.
- Acknowledge that you may use independent contractors, emphasizing that you do not supervise their work and maintain the necessary written agreements.
- Make sure to affirm your understanding of the requirements for compliance if your status changes in the future.
- Affirm that you have the authority to sign the affidavit on behalf of your company, using the designated fields for this information.
- Finally, review your entries for accuracy before saving your changes. You have the option to download, print, or share the completed form after you confirm that all provided information is correct.
Complete your documents online today for a smooth filing experience.
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