 |
(Use the
Tab Key
to navigate)
|
Employment Tools that make a Difference
|
|
|
109 West Main
Trinidad, CO 81082
719-845-0062 Ph
719-845-1071 Fax
|
Contact
Denise Render
719-845-0062 #106
deniser@centurysolutions.org
|
|
|
Company Name
|
|
|
|
|
|
|
|
Title
|
|
|
|
Address
|
|
|
|
Mailing Address
(if different
than above)
|
|
|
|
Phone
|
|
|
|
Fax
|
|
|
|
Email
|
|
|
|
FEIN
|
|
|
|
Number of Employees
|
|
|
|
Type of Business Entity
(check one)
|
C Corp
S Corp
LLC
Partnership
Proprietorship
Non-Profit
Other
|
|
|
Description of Operations
(what does your
company do?)
|
|
|
|
PAYROLL
|
|
|
|
If Payroll is currently done
in-house, how many hours
per month?
|
|
|
|
If Payroll is currently done
out of house, how much is
the monthly fee?
|
|
|
|
Do you currently offer
direct deposit?
|
|
|
|
If so, what are the fees?
|
|
|
|
What is your Gross monthly
payroll amount?
|
|
|
|
UNEMPLOYMENT TAXES
|
|
|
|
What is your current State
Unemployment Rate?
|
|
|
|
WORKER’S COMP
|
|
|
|
Please fill out the following:
|
Class Code/Job Description• # FT Emp• # PT Emp• Annual PR
|
|
|
|
|
|
|
What is your current
Work Comp Modifer?
|
|
|
|
HEALTH INSURANCE
BENEFITS
|
Do you currently offer group health insurance benefits?
If so, please list your current rates.
|
|
|
|
|
|
|
ES
|
|
|
|
EC
|
|
|
|
EF
|
|
|
|
What is your current plan’s
deductible and prescription
benefit?
|
|
|
|
Please list the following
information for those to
be covered under the
group health insurance plan.
|
Gender, Date of Birth, Coverage Election Type (EE,ES,EC,EF)
|
|
|
Are you interested in offering
AFLAC products at no
additional cost?
|
|
|
|
HUMAN RESOURCES
|
|
|
|
How do you currently
recruit for open positions?
|
|
|
|
Do you have a person
in-house that is responsible
for maintaining all regulated
taxation paperwork? If so,
how many hrs per month?
|
|
|
|
Do you have an up-to-date
employee manual?
|
|
|
|
RETIREMENT
|
|
|
|
Do you currently offer an
employee retirement plan
such as a SIMPLE IRA or a
401(k)?
|
|
|
|
If not, would you be
interested in adding this
as a benefit?
|
|
|
|
If you currently offer an
employee retirement plan,
what are the annual fees
that you pay to a broker or
consultant?
|
|
|
|
|
|
|
|
|
Thank you for your interest in Strategic Staffing Solutions.
|
|
|
 |
We will review this information promptly and return to you with a quote.
|
|