Washington Application For Self-Insurance Certification is a form required by the Washington State Department of Labor & Industries (L&I) for employers who wish to become self-insured for workers’ compensation purposes. This form must be completed and submitted to the L&I Self-Insurance Unit for review and approval before an employer can become self-insured for workers’ compensation in Washington State. There are two types of Washington Application for Self-Insurance Certification: the first is for employers who wish to become self-insured for workers’ compensation, and the second is for employers who wish to become self-insured for industrial insurance. The application requires employers to provide basic information about themselves and their business, as well as information regarding any associated entities and the ability to provide financial security for the self-insurance program. Additionally, employers must provide information related to the risk management and safety programs they have in place, as well as any current claims experience.